Single shot spinal anesthesia for high order repeat cesarean section deliveries.
Abstract Number: T-22
Abstract Type: Original Research
Introduction: High order repeat Cesarean Section [4th or more (HOR-C/S)] is associated with fibrotic adhesions, increased risk of injury to adjacent viscera, excessive rates of placenta previa and various degrees of adherent placenta. In a previous publication we demonstrated that perioperative complications occurred in only 3/108 cases of HOR-C/S and conversion from regional to general anesthesia was required in only 5/95 cases of HOR-C/S (1). The current prospective 1 year’s observational study was designed to examine whether our practice findings are consistent, providing further basis for our observation that single shot spinal anaesthesia suffices for most uncomplicated HOR-C/Ss. There were no exclusion or dropout criteria. Results: The study cohort included 831 women with an average age of 31.5±6.2 years. There were overall 129 parturients undergoing HORCS and 702 parturients undergoing first to third C/Ss (“regular C/S”). Single shot spinal anesthesia was performed more commonly in HOR-C/S than in regular CS. Operative times were significantly longer in HOR-C/Ss. Dehiscence of the previous scar occurred in 3 regular C/Ss (1%) and 3 HOR-C/Ss (2.3%). There were also 5 cases with uterine rupture: two in HOR-C/S (1.5%) and 3 in regular C/Ss (0.5%). Although the anesthesiologists estimated blood loss similarly in both groups (0.69±1L vs. 0.55±0.32L p=0.106 in HOR-C/S and regular C/Ss respectively), the rate of red blood cell transfusion was higher in the HOR-C/Ss . Despite the differences in surgery, the rate of conversion from regional to general anesthesia was exactly similar in the two groups (1.6%). Conversion from regional to general anesthesia due to massive hemorrhage with hemodynamic instability was not required in any of the HOR-C/S s but was performed in two regular C/Ss. All other conversions were due to either inadequate epidural anesthesia or failed spinal anesthesia. (Table). The observation period in the post anesthesia care unit was prolonged in 28/702 (4.0%) regular C/Ss and 10/129 (7.7%) HOR-C/Ss. Ongoing hemorrhage was observed in 10/702 (1.4%) regular C/Ss and 2/129 (1.5%) HOR-C/Ss. Neonatal outcome were similar in the two groups. Discussion and Conclusion: The most important finding in this study is that despite higher rates of adhesions, slightly more hemorrhage and longer surgical procedures. The current study supports our previous retrospective data which also showed that single shot spinal cans suffice for HORCS provided