Obstetric spinal analgesia and anesthesia

PURPOSE OF REVIEW: The present overview will try to summarize the most important recent studies performed on spinal analgesia for labor pain treatment and spinal anesthesia for Cesarean section. RECENT FINDINGS: Attention is focused on pharmacological and technical topics. The interest in demonstrating the benefits of the new local anesthetics over bupivacaine seems to have faded. The search for other adjuvant drugs continues, but it is not clear whether opioids need to be replaced or combined with other adjuvants. A large number of studies are still dealing with vasopressor treatment of hypotension during Cesarean section. There is growing evidence that ephedrine is no longer the vasopressor drug of choice and that phenylephrine should take its place. In technical studies, discussion on combined spinal-epidural versus epidural continues, but it remains difficult to provide definitive evidence that combined spinal-epidural is more advantageous. Also the increased possibility of ambulation has not resulted in benefits other than enhanced maternal satisfaction. Finally, spinal techniques seem to have lost their reputation as being a dangerous choice in patients with severe preeclampsia or cardiac disease. SUMMARY: The new local anesthetics have established their position in obstetric regional anesthesia, but it remains difficult to demonstrate a superior outcome as compared with bupivacaine. The same is true for combined spinal-epidural and ambulation. Phenylephrine seems to have become the vasopressor of choice in the treatment of hypotension following spinal anesthesia. A more appropriate treatment of hypotension combined with a low-dose technique may enhance the safety of spinal anesthesia in preeclamptic patients or cases of severe cardiac disease.