Malegari Asiel Christopher 1 , Vudayagiri Ravisankar 2 , S. Jyothi 3 , Alagandala Anuradha 4
Our primary aim is to analyze of maternal and fetal outcome in spinal versus epidural anesthesia for cesarean delivery in severe pre-eclampsia. MATERIALS AND METHODS Sixty parturients (60) with severe pre-eclampsia posted for cesarean section were randomized into two groups of thirty (30) each for either spinal anesthesia that is group S or epidural anesthesia that is group E. Spinal group (group S, n=30) received 10mg (2ml) of 0.5% of hyperbaric bupivacaine solution intrathecally in left lateral decubitus or sitting position at L3-4 lumbar space with 25G quincke-babcock spinal needle. Patients received 6l/min of oxygen through Hudson’s face mask throughout the surgery. In Epidural group (group E, n=30), after thorough aseptic precautions, an 18G Tuohy’s epidural needle inserted at the L3-4 lumbar space with the patient in lateral decubitus or sitting position. Three ml of 1.5% lidocaine with was given as a test dose. After ruling out any intrathecal injection of the drug, initially 8ml of 0.5% isobaric bupivacaine given and the vitals monitored. Then 3ml top-ups of the same bupivacaine solution is given in a graded manner slowly, simultaneously checking the height of block. A blockade upto T4 to T6 is required. Vitals are carefully monitored and oxygen is provided 6l/min throughout the procedure and surgery. Blood pressure (systolic, mean, diastolic), pulse rate, oxygen saturation are recorded immediately after giving anesthesia, every minute for first 10mins, then every 3mins for the rest of the surgery. Then vitals are also noted post-operatively for the first 24hrs. Apgar score after 1 and 5 minutes, of the newborn baby is also recorded. Other parameters noted were incidence and duration of hypotension or hypertension both intra-operatively and post-operatively, any usage of vasopressors (ephedrine) and its dose, convulsions, renal failure, pulmonary edema, requirement for ICU stay and the number of days in the mother, and the incidence of fetal demise. CONCLUSION In conclusion, although the incidence of hypotension and ephedrine requirement was slightly more frequent in the spinal group than in the epidural group, we found evidence that supports the use of spinal anesthesia in severely pre-eclamptic patients.