Regional versus general anaesthesia for caesarean section
Abstract
Background
Regional and general anaesthesia (GA) are commonly used for caesarean section (CS) and both have advantages and disadvantages. It is important to clarify what type of anaesthesia is more efficacious.
Objectives
To compare the effects of regional anaesthesia (RA) with those of GA on the outcomes of CS.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 1), MEDLINE (1966 to December 2005), and EMBASE (1980 to December 2005).
We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 1 October 2009 and added the results to the awaiting classification section.
Selection criteria
Randomised and quasi‐randomised controlled trials evaluating the use of RA and GA in women who had CS for any indication.
Data collection and analysis
Two authors independently assessed trials for inclusion, data extraction and trial quality.
Main results
Sixteen studies (1586 women) were included in this review.
Women who had either epidural anaesthesia or spinal anaesthesia were found to have a significantly lower difference between pre and postoperative haematocrit (weighted mean difference (WMD) 1.70, 95% confidence interval (CI) 0.47 to 2.93, one trial, 231 women) and (WMD 3.10, 95% CI 1.73 to 4.47, one trial, 209 women). Compared to GA, women having either an epidural anaesthesia or spinal had a lower estimated maternal blood loss (WMD ‐126.98 millilitres, 95% CI ‐225.06 to ‐28.90, two trials, 256 women) and (WMD ‐84.79 millilitres, 95% CI ‐126.96 to ‐42.63, two trials, 279 women). More women preferred to have GA for subsequent procedures when compared with epidural (odds ratio (OR) 0.56, 95% CI 0.32 to 0.96, one trial, 223 women) or spinal (OR 0.44, 95% CI 0.24 to 0.81, 221 women). The incidence of nausea was also less for this group of women compared with epidural (OR 3.17, 95% CI 1.64 to 6.14, three trials, 286 women) or spinal (OR 23.22, 95% CI 8.69 to 62.03, 209 women).
No significant difference was seen in terms of neonatal Apgar scores of six or less and of four or less at one and five minutes and need for neonatal resuscitation with oxygen.
Authors' conclusions
There is no evidence from this review to show that RA is superior to GA in terms of major maternal or neonatal outcomes. Further research to evaluate neonatal morbidity and maternal outcomes, such as satisfaction with technique, will be useful.
[Note: The nine citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
PICOs
Plain language summary
Regional versus general anaesthesia for caesarean section
Regional compared with general anaesthesia for caesarean section.
Caesarean section is when a baby is born through an incision in the mother's abdomen and uterine wall. This requires effective anaesthesia which can be regional (epidural or spinal) or a general anaesthetic. With regional epidural anaesthesia, the anaesthetic is infused into the space around the mother's spinal column, whilst with regional spinal anaesthesia, the drug is injected as a single dose into the mother's spinal column. With the two types of regional anaesthesia, the mother is awake for the birth but numbed from the waist down. With general anaesthesia, the mother is unconscious for the birth with the anaesthetic affecting her whole body. As well as women having a view as to whether they might wish to be awake or asleep for the caesarean birth, it is important to know the balance of the benefits and adverse effects of these different types of anaesthesia. The review of trials sought to assess these benefits and harms, and identified sixteen randomised controlled trials involving 1586 women. There were some differences which favoured general anaesthesia, for example, less nausea and vomiting. There were also some differences which favoured regional anaesthesia, for example, less blood loss and less shivering. The evidence on the differences in pain was difficult to evaluate. There were not enough participants to assess the very rare outcome of mortality for the mother, which may be an important aspect. None of the trials addressed important outcomes for women like recovery times, effects on breastfeeding, effects on the mother‐child relationship and length of time before mother feels well enough to care for her baby. As there is insufficient evidence on benefits and adverse effects, women are most likely to choose anaesthesia for caesarean section, depending on whether they wish to be awake or asleep for the birth.
