General versus spinal anaesthesia for caesarean section: a quasi-controlled trial.

BACKGROUND: General anaesthesia and spinal anaesthesia are commonly used for caesarean sections. The aim of this study was to compare the outcomes from caesarean sections with these two types of anaesthesia.

METHODS: In this quasi-controlled trial, we enrolled women undergoing caesarean sections at Al-Helal Al-Emirati Hospital, Rafah, Gaza Strip. Women were assigned either to general anaesthesia (20% intravenous propofol for anaesthesia induction followed by atracurium for muscle relaxation, and nitrous oxide and oxygen for anaesthesia maintenance) or to spinal anaesthesia (0·5% hyperbaric solution bupivacaine with 20 μg fentanyl intrathecally). Outcome measures were length of hospital stay, length of operation, postoperative pain assessment by visual analogue scales (VAS; range 0-10, where 0 is no pain and 10 is very bad pain) 1 hour after the operation, time from anaesthesia to demand for analgesia, amount of analgesics used in 24 h, and headache after the operation. Data were analysed using SPSS version 20. Groups were compared using the Mann-Whitney U-test, Student's t test, and odds ratio. A p value less than 0·05 was significant. The study was approved by the hospital ethics committee, and verbal informed consent was obtained from each participant.

FINDINGS: 181 women (aged 19-46·5 years) were enrolled in this study. 79 women received general anaesthesia, and 102 women received spinal anaesthesia. The women did not differ in baseline characteristics such as mean age (30·6 years [SD 6·5] in the general anaesthesia group vs 28·5 years [5·4] in the spinal anaesthesia group; p=0·077), and weight (82·2 kg [SD 14·2] vs 28·5 kg [5·4]; p=0·263). We found no difference between the groups in length of hospital stay (38·7 h [SD 14·5] vs 40·1 h [12·5]; p=0·541), duration of caesarean section (39·9 min [SD 10·1] vs 41·6 min [9·1]; p=0·077), time to demand for analgesia (2·4 h [SD 2·0] vs 2·5 h [1·1]; p=0·634), and hospital readmission (odds ratio 0·77, 95% CI 0·11-5·59). VAS 1 h after the operation was higher in the general anaesthesia group than in spinal anaesthesia group (5·43 [SD 2·9] vs 2·38 [2·32]; p=0·001). Fewer patients who had general anaesthesia needed second and third analgesics than patients who had spinal anaesthesia (23% of women in the general anaesthesia group vs 47% of women in spinal anaesthesia group needed two analgesics; 4% vs 27% needed three or more analgesics; p<0·0001). Two patients in the spinal anaesthesia group had headache after the operation (OR 0·559, 95% CI 0·490-0·636).

INTERPRETATION: General and spinal anaesthesia had a similar safety profile and can be applied according to patients' needs and medical situation in the hospital.

FUNDING: None.