Combination of Small Doses of Subarachnoid Bupivacaine/Fentanyl and Epidural Bupivacaine in Combined Spinal-Epidural Anesthesia for Cesarean Section / 대한마취과학회지

ABSTRACT

BACKGROUND: An intrathecal injection of a small-dose local anesthetic and an opioid using combined spinal-epidural anesthesia (CSEA) technique is a new trend in regional anesthesia for cesarean section. Prophylactic epidural injection may be useful to complete the new regimen. METHODS: Spinal anesthesia via the CSEA technique was performed with 6 mg 0.5% hyperbaric bupivacaine plus 20ng fentanyl in 75 parturients undergoing cesarean section. group S (study, n = 38) received an epidural injection of 10 ml of 0.25% bupivacaine 5 min after intrathecal injection, and was compared with group C (control, n = 37) in sensory levels and Bromage scores, incidences of side effects such as hypotentsion, pain and discomfort, nausea and vomiting, dizziness, pruritus and shivering. Recovery times from sensory and motor block and the duration of postoperative analgesia were assessed between the groups. RESULTS: Sensory block levels were higher (but remained epidural injection through the operation and Bromage scores (BS) were also higher at the end of surgery in group S. Incidences in pain and discomfort (P = 0.004) and pruritus (P = 0.028) were lower in group S. All recovery time variables such as T10 regression time, complete motor recovery time and the duration of postoperative analgesia were longer in group S (P CONCLUSIONS: Small-dose (6 mg) bupivacaine plus 20ng fentanyl was insufficient in 30% of cesarean patients. We obtained supreme analgesia without higher blocks and more side effects after a prophylactic epidural injection of 25 mg bupivacaine.