ABSTRACT
This study was carried out in Assiut University Hospital in the Department of Obstetrics and Gynecology, in the period from January 2002 to January 2003. The study was approved by our local institutional ethics committee. All patients had been informed about the nature of the study and a written or verbal consent was obtained from each one. Forty parturients with mild pre-eclampsia [systolic blood pressure 140-160mm/Hg diastolic blood pressure 90-100mm/Hg] undergoing cesarean section, with no contraindication for regional anesthesia [sepsis,bleeding tendency, severe stenotic valvular heart disease and platelet count < 100000 mm3] were enrolled in the study. General and obstetric examination as well as obstetric ultrasonography were done for all women. Patients were allocated randomly into two groups; group 1 received spinal anesthesia, bupivacain 0.5% [[8-12 mg] [2-2.5ml]] and group II received epidural anesthesia, bupivacain 0.5% [[30 -40 mg] [6 -8ml]] and lidocaine 2% [[120-160 mg] [6- 8ml]]. Hemodynamic data [systolic, diastolic, mean blood pressure and heart rate] were recorded immediately before induction of anesthesia and every 5 minutes after induction till the end of the operation. Neonatal outcome was assessed by Apgar score at I minute and 5 minutes any infra-operative complication was recorded. Amount of blood loss was subjectively assessed by the obstetrician. The quality of anesthesia was assessed in the two groups by sensory level determination and Bromage scale for motor block assessment, subjective assessment of the quality of anesthesia was done using VRS scales. Amount of crystalloid fluid and ephedrine doses were estimated. Side effects such as hypotension, bradycardia, nausea, and vomiting were recorded. The study showed that: Blood pressure decreased significantly after induction of regional block at 5, 10 and 15 minutes than the baseline value in the two groups, where it was lower in group I than group II. Heart rate decreased significantly after induction of regional block than the baseline value in both groups but was within the physiologic range. Neonatal outcome was favorable in both groups, Apgar score at 1 minute and 5 minutes >8 points. No recorded intra-operative complications and blood loss was average. As regards the quality of anesthesia The motor and sensory block were more pronounced in spinal group than epidural group, the patients were more satisfactory and comfortable in spinal than epidural group. The amounts of crystalloid fluid and ephedrine used for prevention and treatment of hypotension were comparable with no significant difference between both groups. Side effects: There were insignificant difference between the two groups as regards nausea, vomiting, bradycardia hypotension and shivering. The regional anesthesia [Spinal-epidural] is a sound choice in mild pre-eclamptic parturient provided that all risk factors [including thrombocytopenia and platelet function defect] are assessed and the patient is stable. The amount of blood loss is within normal and the neonatal outcome is satisfactory. Spinal anesthesia is superior to epidural anesthesia, because both techniques have similar haemodynamic changes and neonatal outcome. However, the spinal anesthesia has many advantages over epidural anesthesia like easy technique, less time consuming, less cost, intense sensory and motor block and patients with spinal anesthesia are more satisfactory than with epidural anesthesia, the surgeon also feels more satisfied. This study was carried out in mild preeclamptic parturient and further studies are needed to evaluate maternal and neonatal safety of these techniques in severe pre-eclampsia