제왕절개술시 경막외 용적 확대를 이용한 척추-경막외 병용마취

Abstract

Background: Epidural volume extension (EVE) via a combined spinal-epidural (CSE) technique involved the enhancement of a small-dose intrathecal block using epidural saline boluses. We compared the EVE technique and single-shot spinal anesthesia with respect to sensory and motor block profiles and hemodynamic stabilities. Methods: Seventy parturients undergoing elective cesarean deliveries were administered either spinal anesthesia with hyperbaric 0.5% bupivacine 10 mg plus fentanyl 15μg or CSE anesthesia (comprising intrathecal hyperbaric 0.5% bupivacine 7 mg with fentanyl 15μg followed by 0.9% saline (5.0 ml)) through a Tuohy needle. In each group, the lowest systolic blood pressure, sensory block level and peak sensory block height to loss of cold sensation to ice were recorded at 1 min intervals. Modified Bromage motor scores and time for sensory regression to the tenth thoracic dermatome (Tlo) were compared between groups in the PACU. Results: Patients in the CSEA group demonstrated significantly faster motor recovery to modified Bromage 0 (82.2 ± 18.7 min versus 121.1 ± 15.2 min respectively, P < 0.05). Conclusions: Our study shows that CSE with EVE provides adequate anesthesia for elective cesarean delivery at only 70% of the bupivacine dose and allows a more rapid motor recovery of the lower limbs, which may have a beneficial impact on PACU stay.