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Intervention Review

Regional versus general anaesthesia for caesarean section

  1. Bosede B Afolabi1,*,
  2. Afolabi FE Lesi2,
  3. Nkihu A Merah3

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 14 AUG 2006

DOI: 10.1002/14651858.CD004350.pub2


How to Cite

Afolabi BB, Lesi AFE, Merah NA. Regional versus general anaesthesia for caesarean section. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004350. DOI: 10.1002/14651858.CD004350.pub2.

Author Information

  1. 1

    University of Lagos, Department of Obstetrics and Gynaecology, Lagos, Nigeria

  2. 2

    College of Medicine of the University of Lagos, Department of Paediatrics and Child Health, Lagos, Nigeria

  3. 3

    University of Lagos, Department of Anaesthesia, Lagos, Nigeria

*Bosede B Afolabi, Department of Obstetrics and Gynaecology, University of Lagos, College of Medicine, PMB 12003, Idi-Araba, Lagos, Nigeria. bosedeafolabi2003@yahoo.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.]

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

針對剖腹產所用的局部與全身麻醉之比較

局部與全身麻醉(GA)都很常被用於剖腹產(CS),而且這2種方法都各有其優點及缺點。重要的是,要釐清哪一種麻醉的類型較為有效。

目標

根據剖腹產的狀況,來比較局部麻醉(RA)的影響與全身麻醉的影響。

搜尋策略

我們搜尋了the Cochrane Pregnancy and Childbirth Group's Trials Register(2005年十二月30日)、the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005年,Issue 1)、MEDLINE(1966年到2005年十二月),以及EMBASE(1980年到2005年十二月)。

選擇標準

不管任何適應症,在接受剖腹產的婦女身上使用局部麻醉與全身麻醉,隨機與半隨機的對照試驗都要進行評估。

資料收集與分析

有2位作者獨立地針對內容評估了這些試驗、資料擷取的狀況,以及試驗的品質。

主要結論

在本篇回顧中共包含了16份研究(1586名婦女)。跟全身麻醉比較起來,不論是曾經接受過硬膜外麻醉(加權平均差(WMD)1.70, 95% 信賴區間(CI)0.47 to 2.93,1份試驗,231位婦女)或是脊髓內麻醉(WMD 3.10, 95% CI 1.73 to 4.47,1份試驗,209位婦女)的婦女,都可以發現她們在手術前與手術後的血球容積比之間的差別明顯地較低。跟全身麻醉比較起來,不論是曾經接受過硬膜外麻醉(WMD −126.98 millilitres, 95% C 225.06 to −28.90,2份試驗,256位婦女)或是脊髓內麻醉(WMD −84.79 millilitres, 95% CI −126.96 to −42.63,2份試驗,279位婦女)的婦女,都有較少的預期母體失血量。跟硬膜外(odds ratio (OR) 0.56, 95% CI 0.32 to 0.96, 1份試驗,223位婦女)或是脊髓內(OR 0.44, 95% CI 0.24 to 0.81,221位婦女)的麻醉比較起來,有較多的婦女會傾向於在後續的過程中使用全身麻醉。跟硬膜外(OR 3.17, 95% CI 1.64 to 6.14, three trials, 286 women)或是脊髓內(OR 23.22, 95% CI 8.69 to 62.03, 20 omen)的麻醉比較起來,全身麻醉組婦女之嘔吐的發生率是較低的。關於在第1及5分鐘時的新生兒Apgar評分法當中得到6分或更少的、以及得到4分或更少的、還有以需要用氧氣進行新生兒復甦,在這些項目中都沒有發現明顯的差異。

作者結論

從本篇回顧之中,就母親或是新生兒重要的預後來看,並沒有任何證據可以顯示局部麻醉會優於全身麻醉。若是有評估新生兒的罹病率以及母親的預後(像是對於技術方面的滿意度)之更進一步的研究,將會帶來很大的幫助。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

針對剖腹產,將局部與全身麻醉進行比較。 剖腹產指的是在母親的腹部與子宮壁上切開一道切口,讓嬰兒可以通過這道切口出生。這樣的過程需要有效的麻醉,而這類的麻醉可以是局部性的(硬膜外或是脊髓內),或全身性的麻醉。若是採用局部的硬膜外麻醉,就要將麻醉劑打到到母親脊柱周圍的空間裡面,至於局部的脊髓內麻醉,則是將藥物以某種單一劑量注射到母親的脊柱裡面。使用這2種類型的局部麻醉時,母親會在生產的時候清醒過來,但是腰部以下都是沒有感覺的。採取全身麻醉的時候,該名母親就不會對生產過程有任何知覺,因為麻醉藥會影響她的全身。當這些婦女可以看得到的時候,不論她們是否會希望在剖腹產的時候維持清醒或是處於睡著的狀態,針對這些不同的麻醉類型,重要的是必須知道它們的優點與副作用之間的平衡。本篇試驗的回顧嘗試著要評估這些優點與危險,並確認了共包含1586名婦女的16組隨機對照試驗。當中有一些差別是會造成對全身麻醉比較偏好,舉例來說,全身麻醉較少有噁心和嘔吐的情況。同樣地,也有一些差別是會造成對局部麻醉比較偏好,舉例來說,因為局部麻醉之血液流失量較少,也比較不會發生顫抖的現象。關於疼痛之差異,很難有足夠的證據加以評估。這些母親的死亡率非常低,所以並沒有足夠的參與者可以進行評估,但是這點卻可能很重要。並沒有任何試驗提到了關於婦女的重要預後,像是復原的時間、對於哺餵母乳的影響、對於母親嬰兒關係的影響、以及在母親的感覺已經好到可以照顧她的寶寶之前所需的時間長度。因為關於優點與副作用方面的證據並不充足,大部分的婦女們還是較傾向當剖腹產選擇麻醉時,是視她們是否希望在生產時處於清醒或睡著的狀態而定。