Low-dose sequential combined spinal-epidural anaesthesia in elective Stark caesarean section: a preliminary cohort study

A. Malvasi, A. Tinelli*, M. Stark**, G. Pontrelli, A. Brizzi***, R.G. Wetzl§, D. Benhamou#

Department of Obstetrics and Gynaecology, “Santa Maria” Hospital, Bari (Italy) *Department of Obstetrics and Gynaecology, “Vito Fazzi” Hospital, Lecce (Italy) **The New European Surgical Academy (NESA), Berlin (Germany) **Department of Anaesthesiology, “Santa Maria” Hospital, Bari (Italy) §Department of Anaesthesiology, “Beaureguard” Hospital, Aosta (Italy) #AP-HP, Service d’Anesthésie-Réanimation, Hôpital Bicêtre, Le Kremlin-Bicêtre (France)

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• Gynecology
• Obstetrics

Aim: To compare combined spinal-epidural anaesthesia (CSE) VS spinal anaesthesia (SA) in caesarean section (CS) performed by Stark method.

Material and Methods: 200 women were prospectively studied before undergoing to a Stark CS in two groups: 95 patients were assigned to a local anaesthesia by SA (first group) and 105 women to CSE anaesthesia (second group). After a pre-load of 500 ml of plasma expander in both groups, SA was performed at the L1-L2 interspace with an injection of 5 ml of levobupivacaine 0.15%, with a 5 mcg of Sufentanil. The CSE was performed by a spinal-epidural injection at the L1-L2 interspace, primarily by 4 ml of levobupivacaine 0.125% and 5 mcg of Sufentanil, then by 3-7 mL of xilocaine carbonate 0.5% plus 1 mcg/ml of Sufentanil. Successively a CS by Stark method was performed in both groups. The recorded anaesthesiologic side effects in two groups were: motor block, intraoperative discomfort, vomiting, bradycardia and hypotension. Statistical evaluation was by Z-Test referred to the comparison of 2 portions with great, independent samples.

Results: In the group with CSE anaesthesia, the prevalence of side effects was less than in the group treated with SA, where the prevalence of the motor block and intraoperative discomfort were greater and statistically significant (p<0.001); so as the vomiting and bradycardia were all in a major percentage in SA group, but only significant for hypotension (p < 0.001).

Conclusions: These preliminary data show that the association between CS and CSE anaesthesia in elective CS by Stark method allow to have less intra and post-operative side effects; further studies need to provide specific details on the anaesthetic and surgical techniques, to tailor and optimize both in each patient to select for surgery.

Corresponding Author: Antonio Malvasi, MD; e-mail: antoniomalvasi@gmail.com