Spinal Versus Epidural Anesthesia for Cesarean Section

Spinal Versus Epidural Anesthesia for Cesarean
Section

Spinal anesthesia has supplanted epidural as the regional anesthetic
of choice for cesarean section in North America. Perceived advantages
include simplicity of technique, rapid administration and onset, reduced
risk of systemic toxicity, and density of anesthetic block. A single prospective
randomized trial has confirmed only minor advantages of spinal
over epidural anesthesia. In a comparison of epidural lidocaine/
epinephrine / fentanyl versus spinal bupivacaine / fentanyl, the latter produced
faster onset, more intense motor block, and slightly better intraoperative
analgesia.30 There were no differences in side effects, postoperative
assessments of intraoperative pain, or satisfaction. A recent
retrospective study has challenged the long-held belief that spinal anesthesia
should be avoided in severe preeclamptics due to potentially
hazardous hemodynamic Unfortunately, sigruficant differences
in the groups compared (epidural versus spinal) due to selection bias
limit conclusions regarding the comparative safety of spinal and epidural
anesthesia in severely hypertensive preeclamptics.