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OBSTETRIC ANESTHESIA

The Effect of Intrathecal Analgesia on the Success of External Cephalic Version

Departments of Anesthesiology and Obstetrics and Gynecology, St. Luke’s-Roosevelt Hospital Center, College of Physicians and Surgeons of Columbia University, New York, New York

Address correspondence to David J. Birnbach, MD, Director of Obstetric Anesthesiology, St. Luke’s-Roosevelt Hospital Center, 1000 Tenth Avenue, New York, NY 10019. Address e-mail to djb2{at}columbia.edu

External cephalic version (ECV), the procedure whereby a fetus in the breech position is converted to vertex, is often performed to avoid an operative delivery. Potential benefits of epidural and spinal anesthesia for this procedure are controversial. Several previous studies have evaluated the use of epidural anesthesia with varying results. We sought to determine whether analgesia produced by subarachnoid sufentanil would safely improve the success of ECV. Patients who received subarachnoid analgesia (n = 20) were compared with those who did not (n = 15) in regard to success of ECV, level of pain during ECV, and satisfaction. ECV was successful in 21 patients (60%), with more frequent success in women who received spinal analgesia as compared with those who did not (80% vs 33%, respectively; P = 0.005). Patients who received spinals also reported smaller pain scores and were more satisfied with ECV. None of the women who received spinal analgesia developed a postdural puncture headache, and the only case of fetal bradycardia occurred in a patient who did not receive spinal analgesia. More profound patient comfort after spinal analgesia may have permitted greater manipulation of the abdomen during ECV, thus improving success rates of ECV without increasing risk.

IMPLICATIONS: The success of external cephalic version (ECV) was compared in women who received spinal analgesia and those who did not. Successful ECV occurred more frequently in those women who received spinal analgesia. Because term singleton pregnancies associated with breech position usually require cesarean delivery, an increase in success of ECV may decrease the number of cesarean deliveries performed.

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				C. F. Weiniger, Y. Ginosar, U. Elchalal, E. Sharon, M. Nokrian, and Y. Ezra External Cephalic Version for Breech Presentation With or Without Spinal Analgesia in Nulliparous Women at Term: A Randomized Controlled Trial Obstet. Gynecol., December 1, 2007; 110(6): 1343 - 1350. [Abstract] [Full Text] [PDF]

				P. T. Choi, S. E. Galinski, L. Takeuchi, S. Lucas, C. Tamayo, and A. R. Jadad PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies: [Les cephalees post-ponction durale sont une complication courante du bloc neuraxial chez les parturientes : une meta-analyse d'etudes obstetricales] Can J Anesth, May 1, 2003; 50(5): 460 - 469. [Abstract] [Full Text] [PDF]

				G. Cherayil, B. Feinberg, J. Robinson, and L. C. Tsen Central Neuraxial Blockade Promotes External Cephalic Version Success After a Failed Attempt Anesth. Analg., June 1, 2002; 94(6): 1589 - 1592. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999