Combining Spinal-Epidural Anesthesia versus Single-Shot Spinal Anesthesia for Cesarean Delivery: A Meta-Analysis of 5 Randomized Controlled Trials

Combined spinal epidural anesthesia in obese parturients undergoing cesarean surgery : A single-blinded randomized comparison of lateral decubitus and sitting positions

BACKGROUND

There is a significant increase in number of obese pregnant women worldwide. Obese parturients undergoing cesarean section have a higher risk for hypotension and require higher doses of vasopressors following spinal anesthesia compared to nonobese parturients.

OBJECTIVE

This study aimed to compare the maternal hemodynamic changes when combined spinal-epidural anesthesia (CSEA) is induced in the left lateral decubitus and sitting positions in obese pregnant women undergoing elective cesarean section.

MATERIAL AND METHODS

In this study, pregnant women with full-term gestation diagnosed as obese undergoing elective cesarean section were included. Two groups were formed: the CSEA was performed in left lateral position in group I (n = 50) and in sitting position in group II (n = 50). At the end of the CSEA procedure, patients were placed in the supine position. When the sensory block reached at the upper level of T6 dermatome, surgery was initiated. Hemodynamic, anesthetic and neonatal parameters were recorded.

RESULTS

In all patients, CSEA was successful and sufficient anesthesia was provided for surgery. Time to reach T6 dermatome sensory level in group II was found to be longer than group I (P = 0.011). At 20 min after spinal injection, the maximum sensory block level was similar in both groups. There were no significant differences between groups in terms of sensory block time and the time to requiring postoperative supplemental analgesics. There were no significant differences in terms of the volume of intravenous fluid administered, ephedrine and atropine requirements between groups. Both groups had similar systolic blood pressure, heart rate and oxygen saturation values during surgery and postoperatively. While both groups had similar diastolic blood pressure (DBP) values during surgery and at the 1st postoperative hour, group II had lower DBP values at the 2nd postoperative hour compared with group I (P = 0.04).

CONCLUSION

Left lateral decubitus and sitting positions during performance of CSEA lead to similar maternal hemodynamic changes in obese pregnant women undergoing cesarean section.

Dexmedetomidine versus fentanyl as adjuvants to ropivacaine for epidural anaesthesia: A systematic review and meta-analysis

BACKGROUND

Several randomized controlled trials (RCTs) have evaluated the use of dexmedetomidine versus fentanyl as adjuvants to ropivacaine for epidural anaesthesia, yet the results are conflicting. We aimed to conduct this meta-analysis to assess the effects and safety of dexmedetomidine and fentanyl as adjuvants to ropivacaine for epidural anaesthesia.

METHODS

Cochrane Library et al databases were searched from inception to Jan 28, 2020. The synthesised effect sizes were presented as mean difference (MD) or odd of risk (OR) and 95% confidence intervals (95% CI).

RESULTS

Nine RCTs with a total of 672 patients were included. The synthesised results indicated that the mean time to the onset of sensory block (MD: -2.82, 95% CI (-4.84, -0.80)), and the time to maximum motor block (MD: -4.35, 95% CI (-7.31, -1.40)) in dexmedetomidine group was significantly less than that of fentanyl group, while the mean time to rescue analgesia in dexmedetomidine group was significantly increased (MD: 99.13, 95% CI (82.89, 115.37)). The incidence of nausea and vomiting (OR: 0.43, 95% CI (0.29, 0.66)), and shivering (OR: 0.34, 95% CI (0.18, 0.63)) in dexmedetomidine group was significantly reduced, yet the incidence of oral dryness in dexmedetomidine group was significantly increased OR: 5.31, 95% CI (1.69, 16.69)).

CONCLUSIONS

Dexmedetomidine is better than fentanyl as adjuvant to ropivacaine for epidural anaesthesia with better effects and less adverse events.