Combining Spinal-Epidural Anesthesia versus Single-Shot Spinal Anesthesia for Cesarean Delivery: A Meta-Analysis of 5 Randomized Controlled Trials.

BACKGROUND This study compared combined spinal-epidural anesthesia (CSEA) and single-shot spinal anesthesia (SSSA) by performing a meta-analysis. MATERIAL AND METHODS An electronic search of relevant studies was done through 2017. Primary endpoints included duration of surgery, and time for (1) sensory recovery to thoracic vertebra (T10), (2) maximal sensory, (3) motor blockade, and (4) motor recovery. Secondary endpoints were the adverse effects. RevMan 5.3 analytical software was used with odds ratios (OR) and 95% confidence intervals (CIs) as the analytic parameters. Standard deviation and mean were used to evaluate data by weighted mean differences (WMDs) with 95% CI. RESULTS A total of 370 patients were analyzed. A similar duration of surgery was observed with CSEA and SSSA (WMD: 0.24, 95%CI: -3.41-3.89; P=0.90). Time to maximal sensory blockade (WMD: 0.96, 95%CI: -2.91-4.83), time to maximal motor blockade (WMD: 0.25, 95%CI: -2.46-2.96), time for complete motor recovery (WMD: -6.28, 95%CI: -29.42-16.86), and time for sensory recovery to T10 vertebra (WMD: 0.42, 95%CI: -11.07-11.91) were not significantly different. Adverse effects such as hypotension (OR: 1.49, 95%CI: 0.27-8.31), pruritus (OR: 0.23, 95%CI: 0.03-2.18), nausea/vomiting (OR: 0.84, 95%CI: 0.12-5.99). and shivering (OR: 0.53, 95%CI: 0.11-2.56) were also similar with CSEA and SSSA. CONCLUSIONS CSEA was not associated with significantly different maximal duration of sensory/motor blockade, complete motor recovery, sensory regression to T10, or adverse drug events compared to SSSA. Hence, both should be considered effective in cesarean delivery.