Skip to main content Accessibility help

Low-dose combined spinal–epidural anaesthesia vs. conventional epidural anaesthesia for Caesarean section in pre-eclampsia: a retrospective analysis

  • M. Van de Velde (a1), N. Berends (a1), B. Spitz (a2), A. Teunkens (a1) and E. Vandermeersch (a1)...



Background and objective: Epidural anaesthesia is the preferred technique of anaesthesia for Caesarean section in pre-eclampsia. Spinal anaesthesia is considered by some as a safe and effective alternative, which is especially useful in emergency situations. Combined spinal–epidural anaesthesia, using low doses of local anaesthetics with opioids, is effective and reduces the incidence of hypotension in normal pregnancy. We performed a retrospective chart analysis to evaluate the effects of combined spinal–epidural anaesthesia on maternal haemodynamics and fetal outcome compared to conventional epidural anaesthesia.

Methods: A retrospective anaesthesia chart analysis of all pre-eclamptic patients who underwent Caesarean section over a 4 yr period was performed. Patient characteristic, obstetric, haemodynamic, fetal and neonatal data were gathered and analysed according to the anaesthetic technique used.

Results: Seventy-seven pre-eclamptic parturients undergoing Caesarean section were identified (26 women were severely pre-eclamptic and 51 demonstrated mild pre-eclampsia). Epidural anaesthesia was performed in 62 patients and combined spinal–epidural anaesthesia was performed in 15. No differences in patient characteristic and obstetric data were noted. Highest mean arterial pressure prior to anaesthesia was comparable between the groups (epidural: 106 ± 12 vs. combined spinal–epidural anaesthesia: 109 ± 18 mmHg) as well as the lowest recorded mean arterial pressure following anaesthesia (epidural: 93 ± 13 vs. combined spinal–epidural anaesthesia: 98 ± 17 mmHg). In the combined spinal–epidural anaesthesia group more ephedrine was used compared to the epidural group (14.6 ± 4.4 vs. 3.6 ± 4.6 mg, P<0.05). However, more lactated Ringer's was used in the epidural group. Umbilical artery pH was lower in the epidural group (7.26 ± 0.01 vs. 7.29 ± 0.02, P<0.05). Similar results were noted in 26 severely pre-eclamptic patients. Seven women underwent combined spinal– epidural anaesthesia and 19 underwent epidural anaesthesia in the severely pre-eclamptic group. Also more ephedrine was used in the combined spinal–epidural anaesthesia group. A tendency towards a lower umbilical artery pH was observed in the epidural group but this difference did not reach statistical significance.

Conclusions: Combined spinal–epidural anaesthesia appears to be safe as anaesthetic technique for pre-eclampsia and severe pre-eclampsia. However, it is important to consider the retrospective design of the study and the large number of epidural anaesthetics performed.


Corresponding author

Correspondence to: Marc Van de Velde, Department of Anaesthesiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium E-mail:; Tel: +32 16 34 42 70; Fax: +32 16 34 42 45


Hide All


Hypertensive disorders in pregnancy. In: Cunningham FG, MacDonald PC, Gant NF, eds. Williams Obstetrics, 18th edn. London, UK: Prentice Hall International Inc., 1989: 653694.
Sibai BM, Mabie BC, Harvey CJ, Gonzalez AR. Pulmonary oedema in severe preeclampsia–eclampsia: analysis of thirty-seven consecutive cases. Am J Obstet Gynecol 1987; 156: 11741179.
Talledo O, Chesley LC, Zuspan FP. Renin–angiotensin system in normal and toxemic pregnancies: differential sensitivity to angiotensin II and norepinephrine in toxemia of pregnancy. Am J Obstet Gynecol 1968; 100: 218221.
Shennan A. Pre-eclampsia. In: Collis R, Plaat F, Urquhart J, eds. Textbook of Obstetric Anaesthesia.London, UK: Greenwich Medical Media, 2002: 221233.
Gatt SP. Hypertensive disorders and renal disease in pregnancy and labor. In: Birnbach DJ, Gatt SP, Datta S, eds. Textbook of Obstetric Anesthesia.Edinburgh, UK: Churchill-Livingstone, 2000: 541552.
Ngan Kee WD, Khaw KS, Lee BB, Lau TK, Gin T. A dose–response study of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg 2000; 90: 13901395.
Mercier FJ, Riley ET, Frederickson WL, Roger-Christoph S, Benhamou D, Cohen SE. Phenylephrine added to prophylactic aphedrine infusion during spinal anesthesia for elective cesarean section. Anesthesiology 2001; 95: 668674.
Hood DD, Curry R. Spinal versus epidural anesthesia for cesarean section in severely preeclamptic patients a retrospective survey. Anesthesiology 1999; 90: 12761282.
Chiu CL, Mansor M, Ng KP, Chan YK. Retrospective review of spinal versus epidural anaesthesia for caesarean section in preeclamptic patients. Int J Obstet Anesth 2003; 12: 2327.
Vercauteren MP, Coppejans HC, Hoffman VH, Mertens E, Adriaensen HA. Prevention of hypotension by a single 5 mg dose of ephedrine during small dose spinal anesthesia in prehydrated cesarean delivery patients. Anesth Analg 2000; 90: 324327.
Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003; 102: 181192.
Clark VA, Sharwood-Smith G, Stewart AVG. Anaesthesia for caesarean section in pregnancy induced hypertension–haemodynamic stability of spinal anaesthesia. Int J Obstet Anesth 2000; 9: 196.
Karinen J, Rasanen J, Alahuhta S, Jouppila R, Jouppila P. Maternal and uteroplacental haemodynamic state in pre-eclamptic patients during spinal anaesthesia for caesarean section. Br J Anaesth 1996; 76: 616620.
Wallace DH, Leveno KJ, Cunnungham FG, Giesecke AH, Shearer VE, Sidawi JE. Randomized comparison of general and regional anesthesia for cesarean delivery in pregnancies complicated by severe preeclampsia. Obstet Gynecol 1995; 86: 193199.
Ramanathan J, Vaddadi AK, Arheart KL. Combined spinal and epidural anesthesia with low doses of intrathecal bupivacaine in women with severe preeclampsia: a preliminary report. Reg Anesth Pain Med 2001; 26: 4651.
Ngan Kee WD, Lee A. Multivariate analysis of factors associated with umbilical arterial pH and standard base excess after Caesarean section under spinal anaesthesia. Anaesthesia 2003; 58: 125130.


Low-dose combined spinal–epidural anaesthesia vs. conventional epidural anaesthesia for Caesarean section in pre-eclampsia: a retrospective analysis

  • M. Van de Velde (a1), N. Berends (a1), B. Spitz (a2), A. Teunkens (a1) and E. Vandermeersch (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed