Low and Ultra-Low CSE Anesthesia in Elective Cesarean Sections. Prospective Randomized and Experimental Study - Pages 44-49

Puertas, E. Guasch, E. Alsina, A. Dominguez, N. Brogly and F. Gilsanz

Department of Anesthesiology, Hospital Universitario La Paz, Madrid, Spain

DOI: http://dx.doi.org/10.14205/2310-9394.2015.03.02.3

Abstract:

Objective: Regional anesthesia is the preferred technique used in elective cesarean sections. The controversy lies in knowing what dose of local anesthetic allows for the safety of both mother and fetus during the procedure. The combined spinal-epidural technique (CSE) allows the intradural dose to be lowered, ensuring an adequate block through additional epidural doses. Our aim was to study the success of the technique.

Method: We carried out a prospective, randomized study of 102 women scheduled for cesarean section. Our objective was to study the incidence of maternal hypotension, the success of the technique, motor block, and repercussions in parameters of fetal well-being after performing a combined technique (CSE) with low and ultra-low doses of hyperbaric levobupivacaine (LB-5mg versus LB-3.75mg) plus epidural extension with 10ml of isobaric levobupivacaine 0.25%.

Results: We found no difference in the incidence of maternal hypotension between our groups. The overall success of the technique was 81.4% directly relating to the length of the surgical procedure. 18.6% of the patients required some type of analgesic booster in the course of the study. We found no difference in the type of neonatal resuscitation used, but there was a statistically significant difference in umbilical cord arterial pH.

Conclusion: The use of low and ultra-low doses can be an alternative in carefully selected cases. The doses used were sufficient for the cesarean section to be performed in the majority of our study subjects. We did not find evident advantages with regard to the incidence of maternal hypotension and we do not believe that the use of ultra-low doses proves beneficial.

Keywords: Local anesthesia, low doses, combined spinal-epidural technique, CSE, cesarean section, maternal hypotension, neonatal resuscitation, fetal pH.