Effectiveness and Safety of Combined Spinal-Epidural Anesthesia in Cesarean Section: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 DIAOMin , LIUHui ,  LINXue-mei

Department of Anesthesia, West China Second Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LINXue-mei, Email: lxm0301@gmail.com

Keywords：

Combined spinal-epidural anesthesia; Cesarean section; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140197

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the effectiveness and safety of combined spinal-epidural anesthesia for cesarean section. Methods We searched The Cochrane Library (Issue 10, 2013), PubMed, MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data for randomized controlled trials on combined spinal-epidural anesthesia for cesarean section up to October 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was conducted using RevMan 5.2.9 software. Results A total of 9 studies containing 616 delivery women were included. The results of meta-analysis showed that:compared with epidural anesthesia, combined spinal-epidural anesthesia was superior in the time of sensory blockade to T4 (MD=-7.38, 95%CI-9.54 to-5.23, P < 0.000 01), muscle relaxation (OR=6.09, 95%CI 2.65 to 13.97, P < 0.000 1), and recovery of motor block (MD=-41.57, 95%CI-58.98 to-24.17, P < 0.000 01). Compare with spinal anesthesia, combined spinal-epidural anesthesia was superior in lowering the incidence of low blood pressure (OR=0.49, 95%CI 0.29 to 0.81, P=0.006). Conclusion Current evidence shows that combined spinal-epidural anesthesia could increase the effectiveness and safety of combined spinal-epidural anesthesia for cesarean section.

Citation： DIAOMin, LIUHui, LINXue-mei. Effectiveness and Safety of Combined Spinal-Epidural Anesthesia in Cesarean Section: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(10): 1218-1224. doi: 10.7507/1672-2531.20140197 Copy

1.	Solangi SA, Siddiqui SM, Khaskheli MS, et al. Comparison of the effects of general vs. spinal anesthesia on neonatal outcome. Anaesth Intens Care, 2012, 16(1):18-23.
2.	Kolatat T, Somboonnanonda A, Lertakyamanee J, et al. Effects of general and regional anesthesia on the neonate (a prospective, randomized trial). J Med Assoc Thailand, 1999, 82(1):40-45.
3.	vanden Berg AA, Sadek M, Swanson S, et al. Epidural Injection of Lidocaine Reduces the Response to Dural Puncture Accompanying Spinal Needle Insertion When Performing Combined Spinal-Epidural Anesthesia. Anesth Analg, 2005, 101(3):882-885.
4.	Rawal N, Holmstrom B, Crowhurst JA, et al. The combined spinal epidural technique. Anesthesiol Clin N A, 2000, 18(2):267-295.
5.	Ithnin F, Lim Y, Sia AT, et al. Combined Spinal Epidural Causes Higher Level of Block than Equivalent Single-Shot Spinal Anesthesia in Elective Cesarean Patients. Anesth Analg, 2006, 102(2):577-580.
6.	Leo B, Sng BL, Lim Y, et al. A Randomized Comparison of Low Doses of Hyperbaric Bupivacaine in Combined Spinal-Epidural Anesthesia for Cesarean Delivery. Anesth Analg, 2009, 109(5):1600-1605.
7.	Higgins JPT, Green S. Assessing risk of bias in included studies:Cochrane Handbook for Systematic Reviews of Interventions5.1.0. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
8.	Choi DH, Kim JA, Chung IS, et al. Comparison of combined spinal epidural anesthesia and epidural anesthesia for cesarean section. Acta Anaesth Scand, 2000, 44(2):214-219.
9.	Patel M, Craig M, Laishley R. A comparison between epidural anaesthesia using alkalinized solution and spinal (combined spinal/epidural) anaesthesia for elective caesarean section. Int J Obs Anesth, 1996, 5(4):236-239.
10.	Rawal N, Schollin J, Wesstrom G. Epidural versus combined spinal epidural block for cesarean section. Acta Anaesth Scand, 1988, 32(1):61-66.
11.	Karaman S, Akercan F, Akarsu T, et al. Comparison of the maternal and neonatal effects of epidural block and of combined spinal-epidural block for Cesarean section. Eur J Obstet Gyn R B, 2005, 121(1):18-23.
12.	Davies SJ, Paech MJ, Welch H, et al. Maternal Experience During Epidural or Combined Spinal-Epidural Anesthesia for Cesarean Section:A Prospective, Randomized Trial. Anesth Analg, 1997, 85(3):607-613.
13.	Lew E, Yeo SW, Thomas E. Combined Spinal-Epidural Anesthesia Using Epidural Volume Extension Leads to Faster Motor Recovery After Elective Cesarean delivery:A Prospective, Randomized, Double-Blind Study. Anesth Analg, 2004, 98(3):810-814.
14.	Thorkn T, Holmstrom B, Rawal N, et al. Sequential Combined Spinal Epidural Block Versus Spinal Block for Cesarean Section:Effects on Maternal Hypotensionand Neurobehavioral Function of the Newborn. Anesth Analg, 1994, 78(6):1087-1092.
15.	Brizzi A, Greco F, Malvast A, et al. Comparison of sequential combined spinal-epidural anesthesia and spinal anesthesia for cesarean section. Minerva Anestesiol, 2005, 71(11):701-709.
16.	Choi DH, Ahn HJ, Kim JA. Combined low-dose spinal-epidural anesthesia versus single-shot spinal anesthesia for elective cesarean delivery. Int J Obs Anesth, 2006, 15(1):13-17.
17.	Choi DH, Park NK, Cho HS, et al. Effects of Epidural Injection on Spinal Block During Combined Spinal and Epidural Anesthesia for Cesarean Delivery. Regional Anesth Pain M, 2000, 25(6):591-595.
18.	Horstman DJ, Riley ET, Carvalho B. A Randomized Trial of Maximum Cephalad Sensory Blockade with Single-Shot Spinal Compared with Combined Spinal-Epidural Techniques for Cesarean Delivery. Anesth Analg, 2009, 108(1):240-245.
19.	Mcander CR, Harms P. Paraesthesiae During Needle-through-Needle Combined Spinal Epidural Versus Single-shot Spinal for Elective Caesarean Section. Anaesth Intens Care, 2003, 31(5):514-517.
20.	Macfarlane AJ, Pryn A, Litchfield KN, et al. Randomised controlled trial of combined spinal epidural vs spinal anaesthesia for elective caesarean section:vasopressor requirements and cardiovascular changes. Eur J Anaesth, 2009, 26(1):47-51.
21.	王春林, 黄唯, 何虹.产妇腰硬联合麻醉硬膜外追加利多卡因和生理盐水对麻醉平面的影响.中华临床医师杂志(电子版), 2013, 7(3), 1018-1012.
22.	Coppejans HC, Hendrickx E, Goossens J, et al. The sitting versus right lateral position during combined spinal-Epidural Anesthesia for Cesarean Delivery:Block Characteristics and Severity of Hypotension. Anesth Analg, 2006, 102(1):243-247.
23.	李峥. CSEA不同穿刺间隙在剖宫产手术中的应用效果.求医问药, 2013, 11(8), 124-125.
24.	Timothy JG, Michael J, Sharon FE. The Effect of intravenous ketorolac on opioid requirement and pain after cesarean delivery. Anesth Analg, 2001, 92(4):1010-1014.

1. Solangi SA, Siddiqui SM, Khaskheli MS, et al. Comparison of the effects of general vs. spinal anesthesia on neonatal outcome. Anaesth Intens Care, 2012, 16(1):18-23.
2. Kolatat T, Somboonnanonda A, Lertakyamanee J, et al. Effects of general and regional anesthesia on the neonate (a prospective, randomized trial). J Med Assoc Thailand, 1999, 82(1):40-45.
3. vanden Berg AA, Sadek M, Swanson S, et al. Epidural Injection of Lidocaine Reduces the Response to Dural Puncture Accompanying Spinal Needle Insertion When Performing Combined Spinal-Epidural Anesthesia. Anesth Analg, 2005, 101(3):882-885.
4. Rawal N, Holmstrom B, Crowhurst JA, et al. The combined spinal epidural technique. Anesthesiol Clin N A, 2000, 18(2):267-295.
5. Ithnin F, Lim Y, Sia AT, et al. Combined Spinal Epidural Causes Higher Level of Block than Equivalent Single-Shot Spinal Anesthesia in Elective Cesarean Patients. Anesth Analg, 2006, 102(2):577-580.
6. Leo B, Sng BL, Lim Y, et al. A Randomized Comparison of Low Doses of Hyperbaric Bupivacaine in Combined Spinal-Epidural Anesthesia for Cesarean Delivery. Anesth Analg, 2009, 109(5):1600-1605.
7. Higgins JPT, Green S. Assessing risk of bias in included studies:Cochrane Handbook for Systematic Reviews of Interventions5.1.0. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
8. Choi DH, Kim JA, Chung IS, et al. Comparison of combined spinal epidural anesthesia and epidural anesthesia for cesarean section. Acta Anaesth Scand, 2000, 44(2):214-219.
9. Patel M, Craig M, Laishley R. A comparison between epidural anaesthesia using alkalinized solution and spinal (combined spinal/epidural) anaesthesia for elective caesarean section. Int J Obs Anesth, 1996, 5(4):236-239.
10. Rawal N, Schollin J, Wesstrom G. Epidural versus combined spinal epidural block for cesarean section. Acta Anaesth Scand, 1988, 32(1):61-66.
11. Karaman S, Akercan F, Akarsu T, et al. Comparison of the maternal and neonatal effects of epidural block and of combined spinal-epidural block for Cesarean section. Eur J Obstet Gyn R B, 2005, 121(1):18-23.
12. Davies SJ, Paech MJ, Welch H, et al. Maternal Experience During Epidural or Combined Spinal-Epidural Anesthesia for Cesarean Section:A Prospective, Randomized Trial. Anesth Analg, 1997, 85(3):607-613.
13. Lew E, Yeo SW, Thomas E. Combined Spinal-Epidural Anesthesia Using Epidural Volume Extension Leads to Faster Motor Recovery After Elective Cesarean delivery:A Prospective, Randomized, Double-Blind Study. Anesth Analg, 2004, 98(3):810-814.
14. Thorkn T, Holmstrom B, Rawal N, et al. Sequential Combined Spinal Epidural Block Versus Spinal Block for Cesarean Section:Effects on Maternal Hypotensionand Neurobehavioral Function of the Newborn. Anesth Analg, 1994, 78(6):1087-1092.
15. Brizzi A, Greco F, Malvast A, et al. Comparison of sequential combined spinal-epidural anesthesia and spinal anesthesia for cesarean section. Minerva Anestesiol, 2005, 71(11):701-709.
16. Choi DH, Ahn HJ, Kim JA. Combined low-dose spinal-epidural anesthesia versus single-shot spinal anesthesia for elective cesarean delivery. Int J Obs Anesth, 2006, 15(1):13-17.
17. Choi DH, Park NK, Cho HS, et al. Effects of Epidural Injection on Spinal Block During Combined Spinal and Epidural Anesthesia for Cesarean Delivery. Regional Anesth Pain M, 2000, 25(6):591-595.
18. Horstman DJ, Riley ET, Carvalho B. A Randomized Trial of Maximum Cephalad Sensory Blockade with Single-Shot Spinal Compared with Combined Spinal-Epidural Techniques for Cesarean Delivery. Anesth Analg, 2009, 108(1):240-245.
19. Mcander CR, Harms P. Paraesthesiae During Needle-through-Needle Combined Spinal Epidural Versus Single-shot Spinal for Elective Caesarean Section. Anaesth Intens Care, 2003, 31(5):514-517.
20. Macfarlane AJ, Pryn A, Litchfield KN, et al. Randomised controlled trial of combined spinal epidural vs spinal anaesthesia for elective caesarean section:vasopressor requirements and cardiovascular changes. Eur J Anaesth, 2009, 26(1):47-51.
21. 王春林, 黄唯, 何虹.产妇腰硬联合麻醉硬膜外追加利多卡因和生理盐水对麻醉平面的影响.中华临床医师杂志(电子版), 2013, 7(3), 1018-1012.
22. Coppejans HC, Hendrickx E, Goossens J, et al. The sitting versus right lateral position during combined spinal-Epidural Anesthesia for Cesarean Delivery:Block Characteristics and Severity of Hypotension. Anesth Analg, 2006, 102(1):243-247.
23. 李峥. CSEA不同穿刺间隙在剖宫产手术中的应用效果.求医问药, 2013, 11(8), 124-125.
24. Timothy JG, Michael J, Sharon FE. The Effect of intravenous ketorolac on opioid requirement and pain after cesarean delivery. Anesth Analg, 2001, 92(4):1010-1014.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Combined Spinal-Epidural Anesthesia in Cesarean Section: A Systematic Review

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