Effective regional anaesthesia for caesarean section can be achieved by both spinal or epidural techniques.
Compared to epidural, spinal anaesthesia allows surgery to begin earlier, but increases the need to treat hypotension. There was no difference shown with respect to failure rate, need for additional intraoperative analgesia, conversion to general anaesthesia intraoperatively, maternal satisfaction, and neonatal intervention. Differences in side-effects such as post dural puncture headache, nausea and vomiting, and postoperative complications needing anaesthetic intervention were inconclusive due to the small numbers reported. No studies reported breastfeeding ability and time to ambulation post surgery.
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Regional anaesthesia (spinal or epidural anaesthesia) for caesarean section is the preferred option when balancing risks and benefits to the mother and her fetus. Spinal anaesthesia for caesarean section is thought to be advantageous due to simplicity of technique, rapid administration and onset of anaesthesia, reduced risk of systemic toxicity and increased density of spinal anaesthetic block.
Objectifs
To assess the relative efficacy and side-effects of spinal versus epidural anaesthesia in women having caesarean section.
Stratégie de recherche documentaire
The Cochrane Pregnancy and Childbirth Group Trials Register (February 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003).
Critères de sélection
Types of studies considered for review include all published randomised controlled trials involving a comparison of spinal with epidural anaesthesia for caesarean section.
Recueil et analyse des données
Two reviewers independently assessed trials for inclusion. Review Manager software was used for calculation of the treatment effect represented by relative risk (RR) and weighted mean difference (WMD) using a random effects model with 95% confidence intervals (CI).
Résultats principaux
Ten trials (751 women) met our inclusion criteria. No difference was found between spinal and epidural techniques with regards to failure rate (RR 0.98, 95% CI 0.23 to 4.24; four studies), need for additional intraoperative analgesia (RR 0.88, 95% CI 0.59 to 1.32; five studies), need for conversion to general anaesthesia intraoperatively, maternal satisfaction, need for postoperative pain relief and neonatal intervention. Women receiving spinal anaesthesia for caesarean section showed reduced time from start of the anaesthetic to start of the operation (WMD 7.91 minutes less (95% CI -11.59 to -4.23; four studies), but increased need for treatment of hypotension RR 1.23 (95% CI 1.00 to 1.51; six studies).
Conclusions des auteurs
Both spinal and epidural techniques are shown to provide effective anaesthesia for caesarean section. Both techniques are associated with moderate degrees of maternal satisfaction. Spinal anaesthesia has a shorter onset time, but treatment for hypotension is more likely if spinal anaesthesia is used. No conclusions can be drawn about intraoperative side-effects and postoperative complications because they were of low incidence and/or not reported.
