In this randomized, multicenter study we compared the hemodynamic effects of spinal and epidural anesthesia for cesarean delivery in severely preeclamptic patients. The epidural group (n = 47) received 2% lidocaine with epinephrine 1:400,000, 18–23 mL, followed by 3 mg of morphine after delivery. The spinal group (n = 53) received 2.2 mL of 0.5% hyperbaric bupivacaine plus 0.2 mg morphine. We hypothesized that the lowest MAP (mean arterial blood pressure, the primary outcome) during the delivery period would have to be at least 10 mm Hg less in the spinal group to be of clinical importance. We found that there was a statistically significant difference in MAP, with more patients in the spinal group exhibiting hypotension (P < 0.001). Although the incidence of hypotension (systolic arterial blood pressure, SAP ≤100 mm Hg) was more frequent in the spinal group than in the epidural group (51% versus 23%), the duration of significant hypotension (SAP ≤100 mm Hg) was short (≤1 min) in both groups. There was more use of ephedrine in the spinal group than in the epidural group (median, 6 versus 0 mg) but hypotension was easily treated in all patients. Neonatal outcomes assessed by Apgar scores and the umbilical arterial blood gas analysis were similar in both groups. Adverse neonatal outcomes (5-min Apgar score <7 and umbilical arterial blood pH <7.20) were found in only 2 premature newborns (weight <1500 g) who were born without maternal hypotension after regional anesthesia. We conclude that the results of this large prospective study support the use of spinal anesthesia for cesarean delivery in severely preeclamptic patients.
IMPLICATIONS: In a prospective randomized multicenter study of severely preeclamptic women undergoing cesarean delivery, spinal anesthesia was associated with a larger decrease in arterial blood pressure and required more treatment with ephedrine than did epidural anesthesia. Hypotension was easily treated with ephedrine, and neonatal outcomes were similar for both groups.
*Department of Anesthesiology, Siriraj Hospital, Faculty of Medicine, Mahidol University; †Department of Anesthesiology, Chulalongkorn University Hospital, Faculty of Medicine; ‡Department of Anesthesiology, Rajvithi Hospital, Tertiary Care Center, Bangkok, Thailand; §Department of Anesthesiology, Faculty of Medicine, Khonkaen University, Khonkaen, Thailand; ∥Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Supported, in part, by Mahidol University Research Fund, Mahidol University, Bangkok.
Accepted for publication February 11, 2005.
Address correspondence and reprint requests to Shusee Visalyaputra, MD, Department of Anesthesiology, Siriraj Hospital, Bangkoknoi, Bangkok, 10700, Thailand. Address e-mail to firstname.lastname@example.org.