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Comparing the epidural surgical anesthesia and spinal anesthesia following epidural labor analgesia for intrapartum cesarean section: a prospective randomized, controlled trial
Abstract Number: T-10
Abstract Type: Original Research
Background: The conversion of epidural labor analgesia (ELA) to epidural surgical anesthesia (ESA) for intrapartum cesarean section (CS) often fails, resulting in intraoperative pain. Spinal anesthesia (SA) can provide a denser sensory block than can ESA. The purpose of this prospective, non-blinded, parallel-arm, randomized trial was to compare the rate of pain-free surgery between ESA and SA following ELA for intrapartum CS.
Methods: Both groups received continuous epidural infusions for labor pain at a rate of 10 ml/h. In ESA group (n = 163), ESA was performed with 2% lidocaine 17 ml mixed with 100 μg fentanyl, 1 : 200,000 epinephrine, and 2 mEq bicarbonate. In SA group (n = 160), SA was induced with 10 mg of 0.5% hyperbaric bupivacaine and 15 μg fentanyl. We investigated the failure rate of achieving pain-free surgery and the incidence of complications between the two groups.
Results: The failure rate of to achieving pain-free surgery was higher in ESA group than in SA group (15.3% vs. 2.5%, P < 0.001). There was no statistical difference between two groups with regard to the rate of conversion to general anesthesia; however, the rate of analgesic requirements was higher in ESA group than in SA group (12.9% vs. 1.3%, P < 0.001). The incidences of high block, nausea, vomiting, hypotension, shivering, and Apgar scores were comparable between the two groups.
Conclusions: SA after ELA is associated with a lower rate of pain-free surgery during intrapartum CS compared to that of ESA after ELA.