Advertisement

Epidural, Spinal, or Combined Spinal Epidural for Cesarean Section

  • I. F. Russell
Conference paper

Abstract

Epidural, spinal or combined spinal epidural (CSE), which should we use for cesarean section? Factors that may influence the decision include the time available, the presence of a working epidural, the mother’s previous experience, the likely duration of surgery, and the presence of maternal pathology especially cardiac, neurological, or previous back surgery. While such factors are often considerations, usually the technique used is entirely due to anesthetist preference.

Keywords

Caesarean Section Spinal Anesthesia Epidural Catheter Epidural Space Elective Caesarean Section 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Shibli KU, Russell IF (2000) A survey of anaesthetic techniques used for caesarean section in the UK in 1997. Int J Obstet Anesth 9: 160–167PubMedCrossRefGoogle Scholar
  2. 2.
    Khor LJH, Jeskins G, Cooper GM, et al (2000) National obstetric anaesthetic practice in the UK 1997/1998. Anaesthesia 55: 1168–1172PubMedCrossRefGoogle Scholar
  3. 3.
    NHS Maternity Statistics, England: 1995-96 tol997-98 http://www.doh.gov.uk/public/sb0114.htm.
  4. 4.
    Datta S, Alper MH (1980) Anesthesia for cesarean section. Anesthesiology 53: 142–160PubMedCrossRefGoogle Scholar
  5. 5.
    Brull SJ, Greene NM (1989). Time-courses of zones of differential sensory blockade during spinal anesthesia with hyperbaric tetracaine or bupivacaine. Anesth Analg 69: 342–347PubMedCrossRefGoogle Scholar
  6. 6.
    Brull SJ, Greene NM (1991) Zones of differential sensory block during extradural anaesthesia. Br J Anaesth 66: 651–655PubMedCrossRefGoogle Scholar
  7. 7.
    Russell IF (1995) Levels of anaesthesia associated with intra-operative pain at caesarean section under spinal or epidural block. Int J Obstet Anesth 4: 71–77PubMedCrossRefGoogle Scholar
  8. 8.
    James KS, Stott SM, McGrady EM, et al (1996) Spinal anaesthesia for caesarean section: effect of Sprotte needle orientation. Br J Anaesth 77: 150–152PubMedCrossRefGoogle Scholar
  9. 9.
    Pan P, Lin Z-F, Lim J, et al (1989) The optimal does of hyperbaric tetracaine spinal anaesthesia for caesarean section. Acta Anaesth Sin 27: 349–352Google Scholar
  10. 10.
    Pedersen H, Santos A, Steinberg E, et al (1989) Incidence of visceral pain during cesarean section: the effect of varying doses of spinal bupivacaine. Anesth Analg 69: 46–49PubMedCrossRefGoogle Scholar
  11. 11.
    Alahuhta S, Kangas-Saarela T, Hollmén AI, et al (1990) Visceral pain during caesarean section under spinal and epidural anaesthesia with bupivacaine. Acta Anaesth Scand 34: 95–98PubMedCrossRefGoogle Scholar
  12. 12.
    Hirabayashi Y, Saitoh K, Fukuda H, et al (1995) Visceral pain during caesarean section: effect of varying dose of spinal amethocaine. Br J Anaesth 75: 266–268PubMedCrossRefGoogle Scholar
  13. 13.
    Santos A, Pedersen H, Finster M, et al (1984) Hyperbaric bupivacaine for spinal anesthesia in cesarean section. Anesth Analg 63: 1009–1013PubMedGoogle Scholar
  14. 14.
    Choi HD, Ahn HJ, Kim MH, et al (2000) Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean section. Reg Anesth Pain Med 25: 240–245PubMedGoogle Scholar
  15. 15.
    Choi HD, Park NK, Cho HS, et al (2000) Effects of epidural injection on spinal block during combined spinal and epidural anesthesia for cesarean section. Reg Anesth Pain Med 25: 591–595PubMedGoogle Scholar
  16. 16.
    Rocco AG, Raymond SA, Murray E, et al (1985) Differential blockade of touch, cold, and pinprick during spinal anesthesia. Anesth Analg 64: 917–923PubMedCrossRefGoogle Scholar
  17. 17.
    Russell IF (1995) Levels of anaesthesia and intraoperative pain at caesarean section under regional block. Int J Obstet Anesth 4: 71–77PubMedCrossRefGoogle Scholar
  18. 18.
    Liu S, Kopacz DJ, Carpenter RL (1995) Quantitative assessment of differential sensory nerve block after lidocaine spinal anesthesia. Anesthesiology 82: 60–63PubMedCrossRefGoogle Scholar
  19. 19.
    Norris MC (1999) Spinal anesthesia for cesarean delivery. In: Norris MC (ed) Obstetric anesthesia, 2nd edn. Lippincott Williams and Wilkins, Philadelphia p 428Google Scholar
  20. 20.
    Yentis SM, Brighouse D, May A, et al (2001) Analgesia, anaesthesia and pregnancy. Saunders, London pp 92–96Google Scholar
  21. 21.
    Bourne TM, deMelo BA, Bastianpillai BA et al (1997) A survey of how British obstetric anaesthetists test regional anaesthesia before caesarean section. Anaesthesia 52: 901–903PubMedCrossRefGoogle Scholar
  22. 22.
    Oyston J. A Guide to Spinal Anaesthesia for Caesarean Section for Anaesthetists&Anesthesiologists. http://www.virtual-anaesthesia-textbook.com.
  23. 23.
    Morgan BM, Magni V, Goroszenuik T (1990) Anaesthesia for emergency Caesarean section. Br J Obstet Gynaecol 97: 420–424PubMedCrossRefGoogle Scholar
  24. 24.
    Crawford JS (1984) Principles and practice of obstetric anaesthesia, 5th edn. Blackwell Scientific Publications, OxfordGoogle Scholar
  25. 25.
    Moir DD, Thorburn J (1990) Factors modifying epidural block for Caesarean section. In: Reynolds F (ed) Epidural and spinal blockade in obstetrics. Ballière Tindall, London pp 151–159Google Scholar
  26. 26.
    Dutton DA, Moir DD, Howie HB, et al (1984) Choice of local anaesthetic drug for extradural caesarean section: comparison of 0.5% and 0.75% bupivacaine and 1.5% etidocaine. Br J Anaesth 56: 1361–1PubMedCrossRefGoogle Scholar
  27. 27.
    Laishley RS, Morgan BM (1988) A single dose epidural technique for caesarean section: a comparison between 0.5% bupivacaine plain and 0.5% bupivacaine with adrenaline. Anaesthesia 43: 100–103PubMedCrossRefGoogle Scholar
  28. 28.
    Norton AC, Davis AG, Spicer RJ (1988) Lignocaine 2% with adrenaline for epidural caesarean section: a comparison with 0.5% bupivacaine. Anaesthesia 43: 844–849PubMedCrossRefGoogle Scholar
  29. 29.
    Howell P, Davies W, Wrigley M, et al (1990) Comparison of four local extradural anaesthetic solutions for elective caesarean section. Br J Anaesth 65: 648–653PubMedCrossRefGoogle Scholar
  30. 30.
    Noble DW, Morrison LM, Brockway MS, et al (1991) Adrenaline, fentanyl or adrenaline and fentanyl as adjuncts to bupivacaine for extradural anaesthesia in elective caesarean section. Br J Anaesth 66: 645–650PubMedCrossRefGoogle Scholar
  31. 31.
    Fernando R, Jones HM (1991) Comparison of plain and alkalinised local anaesthetic mixtures of lignocaine and bupivacaine for elective extradural caesarean section. Br J Anaesth 67: 699–703PubMedCrossRefGoogle Scholar
  32. 32.
    Price ML, Reynolds F, Morgan BM (1991) Extending epidural blockade for emergency caesarean section. Evaluation of 2% lignocaine with adrenaline. Int J Obstet Anesth 1: 13–18PubMedCrossRefGoogle Scholar
  33. 33.
    Clarke V, McGrady E, Sugden C, et al (1994) Speed of onset of sensory block for elective extradural caesarean section: choice of agent and temperature of injectate. Br J Anaesth 72: 221–223CrossRefGoogle Scholar
  34. 34.
    Gaiser RR, Cheek TG, Gutsche BB (1994) Epidural lidocaine versus 2-chloroprocaine for fetal distress requiring urgent cesarean section. Int J Obstet Anesth 3: 208–210PubMedCrossRefGoogle Scholar
  35. 35.
    Gaiser RR, Cheek TG, Adams HK, et al (1998) Epidural lidocaine for cesarean delivery of the distressed fetus. Int J Obstet Anesth 7: 27–31PubMedCrossRefGoogle Scholar
  36. 36.
    Lucas DN, Ciccone GK, Yentis SM (1999) Extending low-dose epidural analgesia for emergency Caesarean section. A comparison of three solutions. Anaesthesia 54: 1173–1177PubMedCrossRefGoogle Scholar
  37. 37.
    Lucas DN, Borra PJ, Yentis SM (2000) Epidural top-up solutions for emergency Caesarean section: a comparison of preparation times. Br J Anaesth 84: 494–496PubMedCrossRefGoogle Scholar
  38. 38.
    Cole P, Dresner M, Stockwell J, et al (2001) Anaesthesia for emergency caesarean section in women already receiving epidural analgesia. Int J Obstet Anesth 10: 214Google Scholar
  39. 39.
    Sprague DH (1976) Effects of position and uterine displacement on spinal anesthesia for cesarean section. Anesthesiology 44: 164–166PubMedCrossRefGoogle Scholar
  40. 40.
    Russell IF (1987) The effect of posture during induction of subarachnoid analgesia for Caesarean section. Right versus left lateral. Br J Anaesth 59: 342–346.PubMedCrossRefGoogle Scholar
  41. 41.
    Inglis A, Daniel M, McGrady E (1995) Maternal position during induction of spinal anaesthesia for caesarean section: a comparison of right lateral and sitting positions. Anaesthesia 50: 363–365PubMedCrossRefGoogle Scholar
  42. 42.
    Russell IF, Holmqvist ELO (1987) Subarachnoid analgesia for caesarean section. A double-blind comparison of plain and hyperbaric 0.5% bupivacaine. Br J Anaesth 59: 347–353PubMedCrossRefGoogle Scholar
  43. 43.
    Graham D, Russell IF (1997) A double-blind assessment of the analgesic sparing effect of intrathecal diamorphine (0.3 mg) with spinal anaesthesia for elective caesarean section. Int J Obstet Anesth 6: 224–230PubMedCrossRefGoogle Scholar
  44. 44.
    Husaini SW, Russell IF (1998) Volume preload: lack of effect in the prevention of spinal-induced hypotension at caesarean section. Int J Obstet Anesth 7: 76–81PubMedCrossRefGoogle Scholar
  45. 45.
    Husaini SW, Russell IF (1998) Intrathecal diamorphine compared with morphine for postoperative analgesia after Caesarean section under spinal anaesthesia. Br J Anaesth 81: 135–139PubMedCrossRefGoogle Scholar
  46. 46.
    Hopkinson JM, Samaan AK, Russell IF, et al (1975) A comparative multicentre trial of spinal needles for caesarean section. Anaesthesia 52: 1005–1011CrossRefGoogle Scholar
  47. 47.
    Stoneham M, Eldridge J, Popat M, et al (1999) Oxford positioning technique improves haemodynamic stability and predictability of block height of spinal anaesthesia for elective Caesarean section. Int J Obstet Anesth 8: 242–249PubMedCrossRefGoogle Scholar
  48. 48.
    Shende D, Cooper GM, Bowden MI (1998) The influence of intradural fentanyl on the characteristics of subarachnoid block for caesarean section. Anaesthesia 53: 706–710PubMedCrossRefGoogle Scholar
  49. 49.
    Sghirlanzoni S, Attanasio A, Delia Grazia L, et al (1995) Spinal anaesthesia for elective caesarean section: comparison of three different anaesthetic solutions. 14th Annual European Society of Regional Anaesthesia Congress, Prague. The International Monitor September: 89Google Scholar
  50. 50.
    Sibilla C, Albertazzi P, Zatelli R, et al (1997) Perioperative analgesia for caesarean section: comparison of intrathecal morphine and fentanyl alone or in combination. Int J Obstet Anesth 6: 43–48PubMedCrossRefGoogle Scholar
  51. 51.
    Swart M, Sewell J, Thomas D (1997) Intrathecal morphine for caesarean section: an assessment of pain relief, satisfaction and side effects. Anaesthesia 52: 373–375PubMedCrossRefGoogle Scholar
  52. 52.
    Kelly MC, Carabine UA, Mirakhur RK (1998) Intrathecal diamorphine for analgesia after caesarean section. A dose finding study and assessment of side-effects. Anaesthesia 53: 231–237PubMedCrossRefGoogle Scholar
  53. 53.
    Moore A, Bullingham R, McQuay H, et al (1984) Spinal fluid kinetics of morphine and heroin. Clin Pharmacol Ther 35: 40–45PubMedCrossRefGoogle Scholar
  54. 54.
    Barkshire K, Russell R, Burry J, et al (2001) A comparison of bupivacaine-fentanyl-morphine with bupivacaine-fentanyl-diamorphine for caesarean section under spinal anaesthesia. Int J Obstet Anesth 10: 4–10PubMedCrossRefGoogle Scholar
  55. 55.
    Eldor J, Guedj P, Gozal Y (1992) Combined spinal-epidural anesthesia using the CSEN. Anesth Analg 74: 169–170PubMedCrossRefGoogle Scholar
  56. 56.
    Wildsmith JAW (1998) Problems with combined spinal epidural anesthesia (editorial). Reg Anesth 23: 388–389CrossRefGoogle Scholar
  57. 57.
    Zarzur E (1998) The posterior epidural space depth. Reg Anesth 23: 108–109CrossRefGoogle Scholar
  58. 58.
    Patel M, Samsoon G, Swami A, et al (1993) Posture and the spread of hyperbaric bupivacaine in parturients using the combined spinal epidural technique. Can J Anaesth 40: 943–946PubMedCrossRefGoogle Scholar
  59. 59.
    Westerbrook JL, Donald F, Carrie LES (1992) An evaluation of a combined spinal/epidural needle set utilising a 26 gauge, pencil point needle for caesarean section. Anaesthesia 47: 990–992CrossRefGoogle Scholar
  60. 60.
    Thompson KD (2001) The use of spinal epidural anaesthesia for elective caesarean section is a waste of time and money. Int J Obstet Anesth 10: 30–32CrossRefGoogle Scholar
  61. 61.
    Yun EM, Marx GF, Santos AC (1998) The effects of maternal position during induction of combined spinal-epidural anesthesia for cesarean delivery. Anesth Analg 87: 614–618PubMedGoogle Scholar
  62. 62.
    Greenhalgh CA (1996) Respiratory arrest in a parturient following intrathecal injection of sufentanil and bupivacaine. Anaesthesia 51: 173–175PubMedCrossRefGoogle Scholar
  63. 63.
    Myint Y, Bailey PW, Milne BR (1993) Cardiorespiratory arrest following combined spinal epidural anaesthesia for Caesarean section. Anaesthesia 48: 684–686PubMedCrossRefGoogle Scholar
  64. 64.
    Budd A, Russell IF (1987) The influence of an epidural fluid challenge on spinal anaesthesia. Obstetric Anaesthetists Association, Spring Meeting, Hull, p20Google Scholar
  65. 65.
    Blumgart CH, Ryall D, Dennison B, et al (1998) Mechanism of extension of spinal anaesthesia by extradural injection of local anaesthetic. Br J Anaesth 69: 457–460CrossRefGoogle Scholar
  66. 66.
    Stienstra R, Dahan A, Alhadi BZR, et al (1996) Mechanism of action of an epidural top up in combined spinal epidural anesthesia. Anesth Analg 83: 382–386PubMedGoogle Scholar
  67. 67.
    Mardirosoff C, Dumont L, Lemédioni P, et al (1998) Sensory block extension during combined spinal and epidural. Reg Anesth Pain Med 23: 92–95PubMedGoogle Scholar
  68. 68.
    Takiguchi T, Okano T, Egawa H, et al (1997) The effects of epidural saline injection on analgesic level during combined spinal and epidural anesthesia assessed clinically and myelographically. Anesth Analg 85: 1097–1100PubMedGoogle Scholar
  69. 69.
    Thorén T, Holmström B, Rawal N, et al (1994) Sequential combined. spinal epidural block versus spinal block for cesarean section: effects on maternal hypotension and neurobehavioural function of the newborn. Anesth Analg 78: 1087–1092PubMedGoogle Scholar
  70. 70.
    Rajakulendran Y, Rahman S, Venkat N (1999) Long-term neurological complication following traumatic damage to the spinal cord with a 25 gauge Whitacre spinal needle Int J Obstet Anesth 8: 62–66PubMedCrossRefGoogle Scholar
  71. 71.
    Reynolds F (2000) Logic in the safe practice of spinal anaesthesia. Anaesthesia 55: 1045–1046PubMedCrossRefGoogle Scholar
  72. 72.
    Reynolds F (2001) Damage to the conus medullaris following spinal anaesthesia. Anaesthesia 56: 238–247PubMedCrossRefGoogle Scholar
  73. 73.
    Parry H (2001) Spinal cord damage. Anaesthesia 56: 290.PubMedCrossRefGoogle Scholar
  74. 74.
    Van Gessel EF, Forster A, Gamulin Z (1993) Continuous spinal anesthesia where do spinal catheters go?Anesth Analg 76: 1004–1007PubMedGoogle Scholar
  75. 75.
    Broadbent CR, Maxwell WB, Ferrie R, et al (2000) Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia 55: 1122–1126PubMedCrossRefGoogle Scholar
  76. 76.
    Hogan QH (1994) Tuffier’s line: the normal distribution of anatomic parameters. Anesth Analg 78: 194–195PubMedCrossRefGoogle Scholar
  77. 77.
    Vegfors M, Cederholm I, Gupta A, et al (1992) Spinal or epidural anaesthesia for elective caesarean section? Int J Obstet Anesth 1: 141–144PubMedCrossRefGoogle Scholar
  78. 78.
    Patel M, Craig R, Laishley R (1006) A comparison between epidural anaesthesia using alkalinized solution and spinal (combined spinal/epidural) anaesthesia for elective caesarean section. Int J Obstet Anesth 5: 236–239CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • I. F. Russell
    • 1
  1. 1.Department of AnaesthesiaHull Royal InfirmaryHullUK

Personalised recommendations