Effects of combinational usage of spinal anesthesia with a low dose of a local anesthetic and epidural anesthesia with a low concentration of local anesthetic solution on hypotension in elective cesarean-section with lateral position

In this study, we aimed to determine whether or not the application of spinal injection of 1ml %0.5 isobaric levobupivacaine followed by an epidural application of 15 ml % 0.25 levobupivacaine on the left supine position and to keep in that position for 15 minutes before converting to the supine position would decrease the incidence and the intensity of hypotension and the nausea-vomiting due to hypotension on pregnant women undergoing elective cesarean-section. Consecutive to the ethical committee?s and the patients approval, 60 pregnant women ages between 18-40 and within ASA physical status 1-2 were included in the study. The 60 cases included in the study. Cases were randomly divided into two groups by the medication that will be injected. 1 ml %0.5 isobaric levobupivacaine to the intrathecal space + 15 ml %0.25 levobupivacaine even though it contained 75 mcg fentanyl was applied to the epidural space in the Group 1 and 2 ml %0.5 isobaric levobupivacaine was applied intrathecally in the Group 2. During the surgery, the hemodynamic data, sensorial block level, ephedrine use and side effects were recorded. When the groups were compared, hemodynamic parameters were more stable and there was less need of ephedrine in the Group 1. There were no significant differences between the two groups in the sensorial block levels and the side effects. We concluded that combined spinal-epidural technique, to support the lower doses of intrathecal local anesthetic with epidural local anesthetic combinations and to keep the left lateral position for 15 minutes, is an appropriate choice depending on the more stable hemodynamic data and more controllable anesthesia obtained in the group 1. Key Words: spinal anesthesia, combined spinal-epidural, Cesarean-section, Levobupivacaine, isobaric