International Journal of Clinical Obstetrics and Gynaecology

Background: Neuraxial anaesthesia is the preferred technique for elective caesarean section. Single-shot spinal anaesthesia is widely used due to its rapid onset but is associated with hypotension and limited duration of analgesia. Combined spinal-epidural anaesthesia offers the advantage of an epidural catheter, which may improve haemodynamic stability and postoperative pain control. Evidence comparing these techniques under contemporary practice remains inconclusive.
Materials and Methods: In this prospective comparative study, 50 ASA I-II parturients scheduled for elective caesarean section were allocated to receive either spinal anaesthesia (Group S, N=25) or combined spinal-epidural anaesthesia (Group C, N=25). Primary outcomes included incidence and severity of hypotension and vasopressor requirement. Secondary outcomes were time to achieve T₄ sensory block, need for intraoperative supplementation, maternal side effects, duration of effective postoperative analgesia, postoperative pain scores using the Visual Analogue Scale (VAS), and maternal satisfaction.
Results: Baseline demographic and haemodynamic parameters were comparable between groups. Time to achieve T₄ sensory block was shorter in Group S (4.2±0.8 min) than Group C (5.1±1.0 min). Hypotension occurred more frequently in Group S (56%) compared with Group C (36%), with higher vasopressor requirement (420±180 µg vs 280±140 µg; p<0.05). Intraoperative supplementation was required more often in Group S (20%) than Group C (8%). Duration of postoperative analgesia was significantly longer in Group C (6.8±1.4 h vs 3.4±0.9 h; p<0.001). Postoperative VAS scores were significantly lower and maternal satisfaction higher in Group C (p<0.05).
Conclusion: Combined spinal epidural anaesthesia provides better haemodynamic stability, superior postoperative analgesia, and higher maternal satisfaction than spinal anaesthesia for elective caesarean section, despite a slightly slower onset of surgical block.