The Combined Spinal Epidural Anesthesia Using Meperidine and Lidocaine for Cesarean Section

Kim, Ae Ra; Park, Jung Hee

Abstract

BACKGROUND
To reduce the disadvantages with both epidural and spinal block, a combined spinal epidural(CSE) technique was introduced by Brownridge in 1981. The effect of the combined spinal-epidural block was compared with the spinal block for elective cesarean section.
METHODS
Fifty healthy parturients were randomly divided into a spinal(n=20) group and a CSE(n=30) group. In the spinal group, 0.5 ml of 5% meperidine(25 mg) mixed with 40~50 mg of 5% hyperbaric lidocaine was injected into the subarachnoid space . In the CSE group, 0.5 ml of 5% meperidine also was injected into the subarachnoid space through a long 26-gauge Quincke needle, which was introduced through an 18-gauge Tuohy needle. An epidural catheter was then inserted and 1.5% lidocaine 7~9 ml was given.
RESULTS
1) The mean time interval from the end of drug injection to T4 sensory block was 3.6?1.0 min in the CSE block and 3.6?1.2 min in the spinal block. The mean level of peak sensory block was T3.3?0.6 in the CSE block and T3.5?0.5 in the spinal block. The time interval between the end of drug injection and Bromage scale 0 of the CSE block(62.1?27.9 min) was significantly (p<0.0001) shorter than the spinal block(102.1?24.0 min). Hypotension ocurred in 14 patients(47%) of the CSE block and 10 patients(50%) of the spinal block. The surgical analgesia was exellent or good in both groups.
CONCLUSIONS
The CSE block using meperidine and hyperbaric lidocaine for cesarean section resulted in rapid onset, good surgical analgesia and rapid motor recovery. And incidence of hypotension of the both groups was not significantly different.