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Anesthesia & Analgesia, Vol 80, 709-712, Copyright © 1995 by International Anesthesia Research Society
Spinal versus epidural anesthesia for cesarean section: a comparison of time efficiency, costs, charges, and complications
ET Riley, SE Cohen, A Macario, JB Desai and EF Ratner
Department of Anesthesia, Stanford University School of Medicine, CA 94305.
Spinal anesthesia recently has gained popularity for elective cesarean
section. Our anesthesia service changed from epidural to spinal anesthesia
for elective cesarean section in 1991. To evaluate the significance of this
change in terms of time management, costs, charges, and complication rates,
we retrospectively reviewed the charts of patients who had received
epidural (n = 47) or spinal (n = 47) anesthesia for nonemergent cesarean
section. Patients who received epidural anesthesia had significantly longer
total operating room (OR) times than those who received spinal anesthesia
(101 +/- 20 vs 83 +/- 16 min, [mean +/- SD] P < 0.001); this was caused
by longer times spent in the OR until surgical incision (46 +/- 11 vs 29
+/- 6 min, P < 0.001). Length of time spent in the postanesthesia
recovery unit was similar in both groups. Supplemental intraoperative
intravenous (i.v.) analgesics and anxiolytics were required more often in
the epidural group (38%) than in the spinal group (17%) (P < 0.05).
Complications were noted in six patients with epidural anesthesia and none
with spinal anesthesia (P < 0.05). Average per-patient charges were more
for the epidural group than for the spinal group. Although direct cost
differences between the groups were negligible, there were more substantial
indirect costs differences. We conclude that spinal block may provide
better and more cost effective anesthesia for uncomplicated, elective
cesarean sections.
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