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Spinal Versus Epidural Anesthesia for Cesarean Section

Colclough, George W. MD

Letter to the Editor

Anesthesiology Department, University of Kentucky College of Medicine, Lexington, KY 40536.

To the Editor:

Riley et al. [1] have overstated the conclusions of their study. The limited clinical comparison performed does not justify the assertion that "spinal block may provide better and more cost effective anesthesia for uncomplicated, elective cesarean sections." The study merely demonstrates that last-minute placement of an epidural catheter in the operating room consumes expensive time and produces unreliable results.

Many anesthesiologists can site an epidural needle faster than they can locate cerebrospinal fluid with a small-gauge spinal needle. A needle-administered test dose followed by 2-chloroprocaine, 20 mL [2] given bevel caudad consistently provides rapid, solid sacral to thoracic blockade. A simple occlusive dressing will hold an epidural catheter until morphine and droperidol can be given after delivery [3]. Even when preceded by chloroprocaine, this combination provides excellent analgesia without worrisome side effects for 18-24 h. Use of chloroprocaine also minimizes postanesthesia care unit stay.

Administration of an epidural anesthetic need not significantly expand operating room time, and any general comparisons involving epidural blockade should recognize its versatility. Broad spinal versus epidural declarations are not supported by Riley et al.'s specific data.

George W. Colclough, MD

Anesthesiology Department, University of Kentucky College of Medicine, Lexington, KY 40536

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1. Riley ET, Cohen SE, Macario A, et al. Spinal versus epidural anesthesia for cesarean section: a comparison of time efficiency, costs, charges, and complications. Anesth Analg 1995;80:709-12.
2. Brooks GZ. Pregnancy and epidural dose requirements. In: Datta S, ed. Obstetric anesthesia. St. Louis: Mosby, 1995;7-14.
3. Naji P, Farschtschian M, Wilder-Smith OH, Wilder-Smith CH. Epidural droperidol and morphine for postoperative pain. Anesth Analg 1990;70:583-8.
© 1995 International Anesthesia Research Society