Low-dose sequential combined spinal-epidural anaesthesia in elective Stark caesarean section: a preliminary cohort study.

Aim: To compare combined spinal-epidural anaesthesia (CSE) VS spinal anaesthesia (SA) in caesarean section (CS) per- formed by Stark method. Material and Methods: 200 women were prospectively studied before undergoing to a Stark CS in two groups: 95 patients were as- signed to a local anaesthesia by SA (first group) and 105 women to CSE anaesthesia (second group). After a pre-load of 500 ml of plasma ex- pander in both groups, SA was performed at the L1-L2 interspace with an injection of 5 ml of lev- obupivacaine 0.15%, with a 5 mcg of Sufentanil. The CSE was performed by a spinal-epidural in- jection at the L1-L2 interspace, primarily by 4 ml of levobupivacaine 0.125% and 5 mcg of Sufen- tanil, then by 3-7 mL of xilocaine carbonate 0.5% plus 1 mcg/ml of Sufentanil. Successively a CS by Stark method was performed in both groups. The recorded anaesthesiologic side effects in two groups were: motor block, intraoperative discomfort, vomiting, bradycardia and hypoten- sion. Statistical evaluation was by Z-Test re- ferred to the comparison of 2 portions with great, independent samples. Results: In the group with CSE anaesthesia, the prevalence of side effects was less than in the group treated with SA, where the prevalence of the motor block and intraoperative discomfort were greater and statistically significant (p<0.001); so as the vomiting and bradycardia were all in a major percentage in SA group, but only significant for hypotension (p<0.001). Conclusions: These preliminary data show that the association between CS and CSE anaesthesia in elective CS by Stark method allow to have less intra and post-operative side effects; further stud- ies need to provide specific details on the anaes- thetic and surgical techniques, to tailor and opti- mize both in each patient to select for surgery.