Korean J Anesthesiol.  1996 Mar;30(3):333-338. 10.4097/kjae.1996.30.3.333.

Combined Spinal Epidural Anesthesia for Cesarean Section

• Kim DH
• Kim SH
• Kim SK
• Park NH

• KMID: 2240410
• DOI: http://doi.org/10.4097/kjae.1996.30.3.333

Abstract

BACKGROUND: The present study was designed to develop a combined spinal epidural (CSE) anesthesia using single segment technique(SST) for cesarean section. We attempted to find the most suitable spinal and epidural local anesthetic doses providing high quality of surgical analgesia and minimal side effects during CSE anesthesia.
METHODS
40 patients scheduled for elective cesarean section under the CSE technique were randomly divided into four groups. 2.5mg(Group 1), 5mg(Group 2), 7.5mg(Group 3) and 10mg(Group 4) of 0.5% hyperbaric bupivacaine was injected into the subarachnoid space through a 26-gauge long Quincke needle. If the block did not reach the T4 level in 15min., it was extended by fractionated doses of 2% lidocaine with 1:200,000 epinephrine administered through the epidural catheter.
RESULTS
All patients in Group 1, 2 and 3 needed epidural lidocaine, 21.0+/-0.8 ml(Group 1), 11.1+/-0.6 ml(Group 2) and 7.4+/-0.7 ml(Group 3). Anesthesia in Group 4 was mostly due to spinal block. Group 2 and 3 resulted in satisfactory anesthesia with rapid onset, good surgical analgesia and muscle relaxation and minimal side effects. Group 1 provided insufficient muscle relaxation and Group 4 had higher incidence(60%) of maternal hypotension than other groups.
CONCLUSIONS
The CSE technique, using 5mg or 7.5mg of subarachnoid bupivacaine and with sufficient epidural lidocaine to reach a T4 level, had the advantages of both spinal and epidural anesthesia with few of the complications of either.

Keyword

Analgesia; Anesthetics; local; bupivacaine; lidocaine; Anesthetic technique; combined spinal epidural; Cesarean section

MeSH Terms

Analgesia
Anesthesia
Anesthesia, Epidural*
Anesthetics
Bupivacaine
Catheters
Cesarean Section*
Epinephrine
Female
Humans
Hypotension
Lidocaine
Muscle Relaxation
Needles
Pregnancy
Subarachnoid Space
Anesthetics
Bupivacaine
Epinephrine
Lidocaine