A RANDOMISED TRIAL OF LOW DOSE COMBINED SPINAL EPIDURAL VERSUS SINGLE SHOT SPINAL ANAESTHESIA IN ELECTIVE CAESAREAN SECTION– EFFECTS ON MATERNAL HYPOTENSION AND FOETAL OUTCOME

SATABDI SARKAR; BIJOY KUMAR BANDYOPADHYAY; DIPASRI BHATTACHARYA; DEBARSHI JANA

Volume : VIII, Issue : VIII, August - 2019

A RANDOMISED TRIAL OF LOW DOSE COMBINED SPINAL EPIDURAL VERSUS SINGLE SHOT SPINAL ANAESTHESIA IN ELECTIVE CAESAREAN SECTION– EFFECTS ON MATERNAL HYPOTENSION AND FOETAL OUTCOME

Satabdi Sarkar, Bijoy Kumar Bandyopadhyay, Dipasri Bhattacharya, Debarshi Jana

Abstract :

It has been seen that sequential Low dose combined spinal epidural anaesthesia(CSE) technique has a lower rate of hypotension (incidence 33%)than single shot SA. Further reduction of the dose of intrathecal local anaesthetics(2.5–7.5mg)in low dose sequential CSE technique reduces the incidence of hypotension in C section. Hence this randomized prospective study was planned for comparison of hypotension induced by low dose CSE and spinal anaesthesia in elective C section . Our study period was from November 2016 to November 2017. During this period all the datas obtained were tabulated in excel sheet.Low dose CSE (n=74) or spinal anaesthesia (n=74)was randomly performed in 148parturients. 4 patients of each group were excluded because of major technical complications. Intrathecal 0.5% hyperbaric bupivacaine22 5 mg added by fentanyl 20 μg followed after 5 min 10 mL of 0.25% epidural bupivacaine was injected into the epidural catheter at L3–L4 space for low dose CSE. Intrathecal 0.5% hyperbaric bupivacaine 10 mg added with fentanyl 20 μg at L2–L3 or L3–L4 interspace was used for spinal anaesthesia68. Blood pressure was recorded every 2 minute till delivery of the baby , thereafter every 3 minute till completion of the surgery. Neonates after delivery were assessed at 1 and 5 minutes by Apgar score and umbilical artery blood gas. All the mothers in both the groups ( CSE group and spinal group )were comparable regarding their demographic , duration of pregnancy as well as preoperative hemodynamic parameters. We found that the SBP was significantly low in spinal group compared to CSE group at almost every observational level till completion of surgery as depicted in different tables and figures. The incidence of hypotension ( p–value: 0.00022) and requirement of phenylephrine were significantly (p–value <0.0001) high in spinal group. Neonatal outcome as assessed by Apgar scoreat at1 minute(p value= 0.1464) , at 5 minute (p=0.1702) and umbilical artery blood gas (p value= 0.5406) was also comparable in both groups. All the results are well corroborated with the results of previously published studies