Abstract
Purpose: Sequential combined spinal-epidural anesthesia (sCSEA) is a technique that uses low-dose intrathecal injection followed by expanding cephalad sensory block via epidural top-up. This study aimed to investigate the validity of sCSEA for cesarean section in pregnant women who may develop severe hypotension after spinal anesthesia.
Materials and methods: We retrospectively reviewed the medical records of pregnant women who underwent cesarean section with combined spinal epidural anesthesia (CSEA) at our institution between January 2013 and December 2017. The cohort was divided into two groups: sequential combined spinal epidural anesthesia (sCSEA group) and conventional combined spinal epidural anesthesia (control group). Patient demographics, comorbidities, anesthesia characteristics, blood pressure changes, and the use of vasopressors and epidural local anesthetic agents were reviewed. Propensity score matching and inverse probability weighting were performed to assess the incidence of hypotension between the two groups.
Results: The study cohort comprised of the sCSEA group (31 pregnant women) and the control group (605 pregnant women). Propensity score matching identified 30 matched pairs (1:1). The frequency of use of vasopressors from the induction of anesthesia to delivery of infants was significantly less in the sCSEA group than in the control group (mean 0.82±0.95 SD, min-max 0 - 3 vs. 2.9±2.9, 0 – 11; p=0.0008). The infused fluid volume during operation was significantly lower in the sCSEA group than in the control group (1287±621, 500–2800 mL vs. 1882±778, 710–4200 mL; p=0.0018). There was no significant change until delivery between the two groups in terms of the decrease in systolic blood pressure from baseline (23.4±10.0, 6.7–52 % vs. 24.5±11.1, 6.7–58.7%; p=0.6727) and mean blood pressure (25.4±10.0, 7.2–48.2% vs. 27.7±10.8, 12.2–58.2%, p=0.3945). A repeated 1:2 (sCSEA : control) matching and inverse probability weighting analysis showed identical results.
Conclusions: The decrease in blood pressure from baseline was identical in both groups. The use of vasopressors and infused fluid volume was significantly less in the sCSEA group than in the control group. Thus, sCSEA can help stabilize blood pressure with less use of vasopressors and infused fluid in pregnant women who may develop severe hypotension after spinal anesthesia.
