Low Dose Combined Spinal-Epidural Anesthesia Versus Conventional Epidural Anesthesia for Elective Cesarean Section in Severe Preeclampsia

Background: Severe preeclampsia is a critical situation which endangers the life of the mother and/or the fetus through decreasing the blood flow to the placenta leading to slow growth, growth retardation, Low birth weight, preterm birth and breathing difficulties to the new born; placental abruption and heavy bleeding, HELLP syndrome (Hemolysis, Elevated Liver Enzymes and Low Platelet count), Eclampsia (preeclampsia plus seizures), cerebrovascular stroke or hemorrhage, pulmonary oedema, renal failure, liver failure, disseminated intravascular coagulopathy and it may end by death.The aim of this study was to compare low dose Combined spinal epidural and conventional epidural anesthesia for elective cesarean section in patients with severe pre-eclampsia as regards safety, efficacy and the best outcome. Methods: Our study included sixty patients with severe preeclampsia undergoing elective cesarean section and they were divided into two groups with thirty patients in each group; GroupI received low dose combined spinal epidural anesthesia under aseptic precautions using 7mg 0.5 %heavy bupivacaine with 25micograms fentanyl intrathecal and incremental doses of 3-5 ml plain bupivacaine in the epidural catheter after10-15 minutes of the intrathecal injection while patients in group II received conventional epidural anesthesia using 16ml 0.5 % plain bupivacaine (after 4ml of lidocaine2 % as a test dose) the 16ml of plain bupivacine 0.5 % were given over 3minutes. Results: In our study, there was no statistical significant difference between the two studied groups regarding the mean arterial pressure, the heart rate and the oxygen saturation (SaO2) of the mother and the umbilical card measurements and APGAR score of the fetus at different time points. Conclusion: The use of low dose combined spinal epidural anesthesia for elective cesarean section in patients with severe pre-eclampsia is as safe, efficient with the same good outcome to the mother and the fetus as conventional epidural anesthes