Spinal versus epidural anaesthesia for caesarean section

Abstract

Regional anaesthesia (spinal or epidural anaesthesia) for caesarean section is the preferred option when balancing risks and benefits to the mother and her fetus. Spinal anaesthesia for caesarean section is thought to be advantageous due to simplicity of technique, rapid administration and onset of anaesthesia, reduced risk of systemic toxicity and increased density of spinal anaesthetic block. To assess the relative efficacy and side‐effects of spinal versus epidural anaesthesia in women having caesarean section. The Cochrane Pregnancy and Childbirth Group Trials Register (February 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003). Types of studies considered for review include all published randomised controlled trials involving a comparison of spinal with epidural anaesthesia for caesarean section. Two reviewers independently assessed trials for inclusion. Review Manager software was used for calculation of the treatment effect represented by relative risk (RR) and weighted mean difference (WMD) using a random effects model with 95% confidence intervals (CI). Ten trials (751 women) met our inclusion criteria. No difference was found between spinal and epidural techniques with regards to failure rate (RR 0.98, 95% CI 0.23 to 4.24; four studies), need for additional intraoperative analgesia (RR 0.88, 95% CI 0.59 to 1.32; five studies), need for conversion to general anaesthesia intraoperatively, maternal satisfaction, need for postoperative pain relief and neonatal intervention. Women receiving spinal anaesthesia for caesarean section showed reduced time from start of the anaesthetic to start of the operation (WMD 7.91 minutes less (95% CI ‐11.59 to ‐4.23; four studies), but increased need for treatment of hypotension RR 1.23 (95% CI 1.00 to 1.51; six studies). Both spinal and epidural techniques are shown to provide effective anaesthesia for caesarean section. Both techniques are associated with moderate degrees of maternal satisfaction. Spinal anaesthesia has a shorter onset time, but treatment for hypotension is more likely if spinal anaesthesia is used. No conclusions can be drawn about intraoperative side‐effects and postoperative complications because they were of low incidence and/or not reported. 針對剖腹產所作的脊髓內與硬膜外麻醉之比較 對於母親與她的胎兒而言，當我們要在其中的風險與優點之間取得平衡時，用於剖腹產的局部麻醉(脊髓內或是硬膜外麻醉)，是婦女們較為偏愛的選擇。脊髓內麻醉用於剖腹產是有助益的，因為技術夠簡單、麻醉藥的給藥與發生作用的時效都很快速、全身性的毒性較低、以及麻醉的阻斷層面密度較高 在接受剖腹產的婦女身上，針對脊髓內與硬膜外麻醉之比較，要評估相關功效與副作用 The Cochrane Pregnancy and Childbirth Group Trials Register(2003年二月)以及the Cochrane Central Register of Controlled Trials(The Cochrane Library，Issue 1，2003年) 本文獻回顧的考量包含了所已發表的隨機對照試驗，其中涵蓋了針對剖腹產所作的脊髓內與硬膜外麻醉之比較 有2位審稿者獨立地針對內容而評估了這些試驗。當中使用了Review Manager軟體來計算治療的功效，並以相對風險(RR)與加權平均差(WMD)來表示，而且使用95% 信賴區間(CI)在內的某種隨機功效模式 共有10組試驗(751名婦女)符合了我們的內容標準。在脊髓內與硬膜外的技術之間，就失敗率(R .98, 95% CI 0.23 to 4.24;4份試驗)、手術中需要額外止痛藥(R .88, 95% CI 0.59 to 1.32; five studies)、手術中需要轉換為全身麻醉、母親的滿意度、手術後疼痛紓解的需求、以及新生兒的介入醫療等方面，這些指標並沒有差異。針對剖腹產而接受了脊髓內麻醉的婦女，在從給予麻醉劑的起始點到手術的起始點之時間較短，加權平均差(WMD)為縮短了7.91分鐘(95% I −11.59 to −4.23; 4份試驗)，但是對於治療低血壓的需求卻增加，RR為1.23(95% I 1.00 to 1.51;6份試驗) 脊髓內與硬膜外的技術，兩者都經證實可以為了剖腹產而提供有效的麻醉。這2種技術都可以帶來中級的母體滿意度。脊髓內之麻醉開始產生作用的時間較短，但是如果使用了脊髓內之麻醉的話，就更需要有對於低血壓的治療。有關於手術中的副作用與手術後的併發症，並沒有辦法歸納出任何結論，因為這些項目的發生率都很低而且/或是沒有被提出過報告 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌 針對剖腹產而言，藉由脊髓內與硬膜外的技術，兩者都可以達成有效的局部麻醉。跟硬膜外比較起來，脊髓內的麻醉可以讓手術提早開始，但是卻會增加對於治療低血壓方面的需求。當考量到失敗率、手術中需要額外之麻醉、手術中轉換為全身麻醉、母親的滿意度，以及新生兒的介入醫療等方面，並沒有發現什麼差異。一些麻醉的副作用，像是硬脊膜穿刺後頭痛、噁心與嘔吐、以及手術後併發症而需要麻醉性醫療等方面，差異是無法確定的，因為報告中所提出的樣本數目都太小了。針對哺餵母乳汁能力與手術後適合下床所需的時間，並沒有研究曾經提出過報告