Comparison of General and Regional Anesthesia for Cesarean Section: Success Rate,Blood Loss and Satisfaction from a Randomized Trial
JARIYA LERTAKYAMANEE, M.D., F.R.C.A.T., F.R.C.A.(UK), M.P.H.*, THITIMA CHINACHOTI, M.D., F.R.C.A.T. **, THARA TRITRAKARN,M.D.,F.R.C.A.T.**, JARINYA MUANGKASEM, B.N.**, ACHRA SOMBOONNANONDA, M.D.***, THRATHIP KOLA TAT, M.D.***
Affiliation : * Department of Anesthesiology, and Clinical Epidemiology Unit, ** Department of Anesthesiology, *** Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok I 0700. Thailand.
Objective : A prospective randomized trial was organized to compare the effectiveness of general and regional anesthesia for cesarean section (CIS).
Method : Three hundred and forty-one patients were randomized into the ~11qal _anes- thesia group (GA), epidural anesthesia group (EA) and ~pinal anesthesia group (SA). The effec- tiveness of interest was success rate, blood loss and patient satisfaction. Result: We found that the success rates of EA and SA were lower than GA. Success in EA should be improved by using an epidural catheter to add more local anesthetic drug instead of a single shot; and the surgeon should allow more time for the block to work adequately. Success in SA should be improved by using bupivacaine instead of lidocaine. GA resulted in significantly more blood loss, lower postoperative hematocrit, and higher proportion of patients who had post- operative hematocrit <30 per cent than EA and SA. The patients' satisfaction scores were not different among the 3 techniques. This meant that, given adequate explanation and perioperative care, Thai women were satisfied with regional anesthesia.
Conclusion : Regional anesthesia is a better choice of anesthesia for CIS than general anesthesia. However, the availability of different techniques and ability to change the technique when needed were very useful and important. If GA is chosen, all safety procedures must be followed. Oxygen supplement and endotracheal intubation facilities must be available in all techniques. Guidelines of anesthesia for CIS at a national level should be agreed upon, including the type of personnel, monitoring equipment and postoperative care.
Keywords : Anesthesia, General, Regional, Cesarean Section
