Combined spinal‐epidural versus spinal anaesthesia for caesarean section

摘要: Background Single-shot spinal anaesthesia (SSS) and combined spinal-epidural (CSE) are both commonly used for caesarean section anaesthesia. Spinals offer technical simplicity rapid onset of nerve blockade which can be associated with hypotension. CSE allows more gradual also prolongation the through use a catheter. Objectives To compare effectiveness adverse effects to single-shot section. Search methods We searched Cochrane Pregnancy Childbirth's Trials Register, ClinicalTrials.gov, WHO International Clinical Registry Platform (ICTRP), reference lists retrieved studies (search date: 8 August 2019). Selection criteria considered all published randomised controlled trials (RCTs) involving comparison further subgrouped as either high-dose (10 or mg bupivacaine), low-dose (less than 10 bupivacaine). Data collection analysis Two review authors independently assessed inclusion risks bias, extracted data checked them accuracy. standard methodological procedures expected by Cochrane. Main results identified 18 including 1272 women, but almost comparisons individual outcomes involved relatively small numbers women. did not report on this review's therefore contribute no towards review. were conducted in national university hospitals Australia (1), Croatia India Italy Singapore (3), South Korea (4), Spain Sweden Turkey (2), UK USA (2). The at moderate risk bias overall.CSE versus anaesthesiaThere may little difference between groups number women requiring repeat regional block general anaesthetic result failure establish adequate initial (risk ratio (RR) 0.32, 95% confidence interval (CI) 0.05 1.97; 7 studies, 341 women; low-quality evidence). uncertain whether having makes any supplemental intra-operative analgesia time after insertion (average RR 1.25, CI 0.19 8.43; 390 very evidence), conversion (RR 1.00, 0.07 14.95; 388 about who satisfied anaesthesia, regardless they received 0.93 0.73 1.19; 2 72 More group (13/21) experienced nausea vomiting treatment (6/21). There 11 cases post-dural puncture headache (5/56 6/57 SSS; 3 trials, 113 women) clear groups. was hypotension (46/86 41/76 4 162 women). babies Apgar score less seven five minutes (4 182 babies).CSE 4.81, 0.24 97.90; 224 Similarly, there is probably 1.75, 0.78 3.92; 298 moderate-quality effect need because required 222 three (low-quality None examined their anaesthesia.The mean effective faster compared CSE, although it unlikely that magnitude clinically meaningful (standardised (SMD) 0.85 minutes, 0.52 1.18 minutes; 160 women).CSE appeared reduce incidence 0.59, 0.38 0.93; 336 Similar (3/50 6/50 1 study, 100 women), (1 138 No infants had an study; 60 babies). Authors' conclusions In review, participants most our analyses some included design limitations. suggestion that, could reduction hypotension, increase treatment. One study found resulted CSE. However, these based limited meaningful. Consequently, currently insufficient evidence support one technique over other needed order evaluate relative safety section.More high-quality, sufficiently-powered area needed. Such consider using listed should reporting economic aspects different under investigation.