///2018 Abstract Details
2018 Abstract Details2018-06-13T16:46:08+00:00

In patients having 4th or more LSCS, is CSE indicated or will a spinal do?

Abstract Number: T3B-1
Abstract Type: Original Research

Muhammad Waseem Athar MD1 ; George Sam Joseph MBBS, MD2; Biju Kurian MBBS, FRCA3

Introduction:

With the number of LSCS rising globally, it’s not uncommon to see patients with history of 3 or more LSCS. This group of patients is thought to get benefit from CSE (combined spinal epidural) in anticipation of prolonged or complicated surgery. It gives the benefit of rapid onset of a high quality block with the option to extend the anesthesia for prolonged surgery or to use for post-operative analgesia. However, CSE has its own risks.

Methods:

The purpose of this study is to assess the usefulness of CSE in patients undergoing 4th or more LSCS. It is a retrospective study conducted over a 6-month period from December 2016 to May 2017. We reviewed the electronic data of 251 patients and compared variables like duration of previous surgeries, BMI, duration of this surgery, anesthetic technique and in cases of CSE whether epidural component was used to extend surgical anesthesia.

Results:

We identified 251 patients. 4 patients came for their 7th LSCS, 8 for 6th, 67 for 5th LSCS and 172 for their 4th LSCS. Out of these, 234(93.2%) patients received central neuraxial anesthesia(CNA) and 17(6.8%) patients received GA. Of 234 CNA cases, 42 patients received CSE and 192 received spinal anesthesia. In only 4 cases of CNA, epidural component of CSE was used for anesthesia intraoperatively. Out of these four patients, 3 patients were found to have adhesions during surgery. Only 3 out of 192 patients who received spinal anesthesia required intravenous rescue analgesia with opioids and 1 needed conversion to GA as surgery went beyond 2 hours.

Discussion:

Our study showed that only 8 out of 234(3.41%) patients with CNA needed supplementation of anesthesia with either epidural top up or IV opioids or conversion to GA for prolonged surgery. The mean time for duration of surgery was 51.62 minutes. It was shown that duration of surgery is not increased with number of LSCS. We conclude that spinal anesthesia is an acceptable choice in this group of patients and CSE technique should be reserved for cases with proven risk factors for prolonged surgery.

References:

1.Betran AP, Torloni MR, Zhang JJ, Gülmezoglu AM. WHO Statement on caesarean section rates. BJOG: An International Journal of Obstetrics & Gynaecology. 2015 Jul 1

2.T Thorén; B Holmström; N Rawal; J Schollin; S Lindeberg; G Skeppner Sequential combined spinal epidural block versus spinal block for cesarean section: effects on maternal hypotension and neurobehavioral function of the newborn. Anesthesia and Analgesia. 78(6):1087-92, JUN 1994

3.Klimek, M., Rossaint, R., van de Velde, M. and Heesen, M. (2018), Combined spinal-epidural vs. spinal anaesthesia for caesarean section: meta-analysis and trial-sequential analysis. Anaesthesia. doi:10.1111/anae.14210

4.Cook T, Counsell D, Wildsmith J. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. British Journal of Anaesthesia. 2009;102(2):179-190

SOAP 2018