Spinal Versus Epidural Anesthesia for Cesarean Delivery in Severe Preeclampsia: A Prospective Randomized, Multicenter Study
ชูศรี พิศลยบุตร, Oraluxna Rodanant, วรรณา สมบูรณ์วิบูลย์, กำธร ตันติวิทยาทันต์, สมบูรณ์ เทียนทอง, วรรณวิมล แสงโชติ
Department of Anesthesiology, Siriraj Hospital, Bangkoknoi, Bangkok, 10700, Thailand. Address e-mail to sisps@mahidol.ac.th.
In this randomized, multicenter study we compared the hemodynamic effects of spinal and epidural anesthesia for cesarean delivery in severely preeclamptic patients. The epidural group (n = 47) received 2% lidocaine with epinephrine 1:400,000, 18–23 mL, followed by 3mg of morphine after delivery. The spinal group (n= 53) received 2.2 mL of 0.5% hyperbaric bupivacaine plus 0.2mgmorphine.Wehypothesized that the lowest MAP (mean arterial blood pressure, the primary outcome) during the delivery period would have to be at least 10mmHg less in the spinal group to be of clinical importance. We found that there was a statistically significant difference in MAP, with more patients in the spinal group exhibiting hypotension (P < 0.001). Although the incidence of hypotension (systolic arterial blood pressure, SAP £ 100 mm Hg) was more frequent in the spinal group than in the epidural group (51% versus 23%), the duration of significant hypotension (SAP £ 100mmHg) was short (£ 1 min) in both groups. There was more use of ephedrine in the spinal group than in the epidural group (median, 6 versus 0 mg) but hypotension was easily treated in all patients. Neonatal outcomes assessed by Apgar scores and the umbilical arterial blood gas analysis were similar in both groups. Adverse neonatal outcomes (5-min Apgar score < 7 and umbilical arterial bloodpH < 7.20) were found in only 2 premature newborns (weight < 1500 g) who were born without maternal hypotension after regional anesthesia. We conclude that the results of this large prospective study support the use of spinal anesthesia for cesarean delivery in severely preeclamptic patients.
Anesthesia and Analgesia ปี 2548, September ปีที่: 101 ฉบับที่ 3 หน้า 862-868