Effects of general anaesthesia versus spinal anaesthesia for caesarean section on postoperative analgesic consumption and postoperative pain

Background and Purpose: Regional anaesthesia is commonly used for elective caesarean section.The aim of this study was to investigate whether there is a positive effect of either general or spinal anesthesia on postoperative analgesic requirements and pain relief. Methods: The level of postoperative analgesia has been compared in 64 women (ASA I or II) scheduled for elective caesarean section. General anaesthesia was performed with propofol, suxamethonium chloride,oxygen, nitrus oxide, and maintenance with 0,5% isoflurane and fentanyl. To achieve a sensory block height to the level of the sixth thoracic dermatome, spinal anaesthesia was performed with hyperbaric 0,5% levobupivacaine and 25 μg fentanyl. For all the patients postoperative analgesia was available on request without any limitation on time by administering the same dose of 75 mg i.m. diclofenac. If the patient had inadequate analgesia it was supplemented with 100 mg s.c. tramadol. Postoperative pain was recorded using visual analogue pain score as well as analgesic requirements over the first 24h after surgery. Results: The time to first request for analgesia was significantly longer in the spinal anesthesia group (p<0.05). At almost all postoperative time points,visual analogue scale scores at rest and during mobilization were lower with spinal anaesthesia (p<0.05). More patients with general anesthesia received supplemental analgesic medication. Conclusion: In parturients undergoing elective caesarean section,spinal anesthesia should be preferred because it is accompanied with less postoperative pain, less use of additional analgesics and less side effects

BRACHIAL PLEXUS PALSY AND HOARSENESS OF THE VOICE DURING LUMBAR EPIDURAL ANALGESIA FOR LABOR AND DELIVERY: A CAUTIONARY TALE

The lumbar epidural analgesia is one of better ways of controlling pain during labor but it still can be followed with complications and unintentional side effects. Neurologic complications of epidural analgesia are rare. We present two cases of healthy women where epidural analgesia was induced during active labor. Repeated intermittent epidural doses of local anesthetics and the left lateral decubitus position of the patients induced the cephalic spread of the anesthetic drug along the epidural space with the appearance of unilateral brachial plexus palsy and hoarseness of the voice. These side effects disappeared spontaneously but caused anxiety in the patients and in all medical staff. Elevated control by anesthetists is necessary in case of epidural analgesia during active labor to avoid risky complications like the high sympathetic block