Department of Obstetrics and Gynaecology, "Santa Maria" Hospital, Bari, Italy.
Eur Rev Med Pharmacol Sci. 2010 Mar;14(3):215-21.
AIM: To compare combined spinal-epidural anaesthesia (CSE) VS spinal anaesthesia (SA) in caesarean section (CS) performed by Stark method. MATERIAL AND METHODS: 200 women were prospectively studied before undergoing to a Stark CS in two groups: 95 patients were assigned 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 expander in both groups, SA was performed at the L1-L2 interspace with an injection of 5 ml of levobupivacaine 0.15%, with a 5 mcg of Sufentanil. The CSE was performed by a spinal-epidural injection at the L1-L2 interspace, primarily by 4 ml of levobupivacaine 0.125% and 5 mcg of Sufentanil, 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 hypotension. Statistical evaluation was by Z-Test referred 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 studies need to provide specific details on the anaesthetic and surgical techniques, to tailor and optimize both in each patient to select for surgery.
目的:比较联合硬膜外麻醉(CSE)与脊髓麻醉(SA)在采用 Stark 方法行剖宫产术(CS)中的效果。 材料与方法:200 名女性前瞻性研究,分为两组,每组 100 例,分别采用 SA(第一组)和 CSE 麻醉(第二组)进行局部麻醉。两组患者均先静脉输注 500ml 血浆扩容剂,然后在 L1-L2 间隙进行 SA 麻醉,注入 5ml 0.15%左旋布比卡因,同时给予 5mcg 舒芬太尼。CSE 麻醉采用 L1-L2 间隙硬膜外-脊髓联合注射,首先给予 4ml 0.125%左旋布比卡因和 5mcg 舒芬太尼,然后给予 3-7ml 碳酸利多卡因 0.5%加 1mcg/ml 舒芬太尼。两组均成功行 Stark 方法 CS。记录两组麻醉相关不良反应:运动阻滞、术中不适、呕吐、心动过缓和低血压。统计学分析采用 Z 检验比较两组大样本、独立样本。 结果:CSE 麻醉组的不良反应发生率低于 SA 麻醉组,其中运动阻滞和术中不适的发生率更高,且具有统计学意义(p<0.001);SA 麻醉组呕吐和心动过缓的发生率均较高,但仅低血压具有统计学意义(p<0.001)。 结论:这些初步数据表明,在采用 Stark 方法行择期 CS 时,CS 与 CSE 麻醉联合应用可减少术中及术后不良反应;需要进一步研究以提供关于麻醉和手术技术的具体细节,以便根据每位患者的情况进行调整和优化,从而选择合适的手术方法。
Eur Rev Med Pharmacol Sci. 2010-3
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