Anesthesia for Cesarean Section: Retrospective Comparative Study

Figures & data

Table 1 Comparison of Different Anesthesia Types in Relation to Different Feto-Maternal Variables in the Elective Cesarean Section Category

Variables	Elective Category
	Epidural	General	Spinal	Total	P-value
	N=85	N=778	N=1485	N=2348
Age (years) mean (SD)	33.4 (5.2)	33.2 (5.2)	33 (5.7)	33.1 (5.5)	0.4760
LOS (days)	3.4 (1.6)	3.63 (2.5)	3.56 (2.4)	3.6 (2.4)	0.6140
Operative time (min)	47.5 (15.5)	47.2 (17.3)	45.9 (13.8)	46.4 (15.1)	0.1230
Blood loss (mL)	748.2 (210)	708.9 (172.2)	742.6 (231.5)	731 (213.4)	0.0010
Apgar-1 minute	8.0 (0.0)	7.9 (0.58)	7.9 (0.480)	7.9 (0.51)	0.0400
Apgar-5 minute	9.0 (0.0)	8.99 (0.13)	8.97 (0.419)	8.9 (0.34)	0.5200
Diclofenac sodium	1.71 (1.1)	1.73 (1.3)	2.05 (1.5)	1.93 (1.5)	0.0000
Morphine sulphate	0.07 (0.258)	0.06 (0.27)	0.04 (0.24)	0.05 (0.25)	0.1420
Pethidine HCL	1.49 (0.88)	1.79 (1.2)	1.55 (1.1)	1.63 (1.1)	0.0000
Paracetamol	2.45 (1.69)	2.75 (2.6)	3.84 (3.0)	3.43 (2.9)	0.0000
Tramadol HCL	0	0.024 (0.29)	0.01 (0.17)	0.02 (0.22)	0.3720
Previous CS
Yes	20 (23.5%)	540 (69.4%)	915 (60.3%)	1475 (62.8%)	<0.0000
No	65 (76.5%)	238 (30.6%)	570 (39.7%)	873 (37.2%)
NICU admission
Yes	33 (38.8%)	387 (49.7%)	590 (39.7%)	1010 (43.0%)	0.0000
No	52 (61.2%)	391 (50.3%)	895 (60.3%)	1338 (57.0%)

Abbreviations: SD, standard deviation; N, number; LOS, length of stay; min, minute; mL, milliliter; HCL, hydrochloride; CS, cesarean section; NICU, neonatal intensive care unit.

Table 2 Multiple Comparisons Using Bonferroni Test; Elective Category

Dependent Variables	Anesthesia	Anesthesia	Mean Difference	Std. Error	Sig.	95% Confidence Interval
						Lower Bound	Upper Bound
LOS (days)	Epidural	General	−.249	0.278	1.000	−.92	0.42
		Spinal	−.182	0.271	1.000	−.83	0.47
	General	Epidural	0.249	0.278	1.000	−.42	0.92
		Spinal	0.068	0.108	1.000	−.19	0.33
	Spinal	Epidural	0.182	0.271	1.000	−.47	0.83
		General	−.068	0.108	1.000	−.33	0.19
Age (years)	Epidural	General	0.144	0.631	1.000	−1.37	1.66
		Spinal	0.413	0.616	1.000	−1.06	1.89
	General	Epidural	−.144	0.631	1.000	−1.66	1.37
		Spinal	0.269	0.245	0.815	−.32	0.86
	Spinal	Epidural	−.413	0.616	1.000	−1.89	1.06
		General	−.269	0.245	0.815	−.86	0.32
Operative time (minutes)	Epidural	General	0.347	1.728	1.000	−3.79	4.49
		Spinal	1.631	1.687	1.000	−2.41	5.67
	General	Epidural	−.347	1.728	1.000	−4.49	3.79
		Spinal	1.284	0.669	0.165	−.32	2.89
	Spinal	Epidural	−1.631	1.687	1.000	−5.67	2.41
		General	−1.284	0.669	0.165	−2.89	0.32
EBL (mL)	Epidural	General	39.302	24.322	0.319	−18.97	97.57
		Spinal	5.676	23.745	1.000	−51.21	62.56
	General	Epidural	−39.302	24.322	0.319	−97.57	18.97
		Spinal	−33.626	9.423	0.001	−56.20	−11.05
	Spinal	Epidural	−5.676	23.745	1.000	−62.56	51.21
		General	33.626	9.423	0.001	11.05	56.20
APGAR score-1m	Epidural	General	0.100	0.058	0.252	−.04	0.24
		Spinal	0.050	0.057	1.000	−.09	0.19
	General	Epidural	−.100	0.058	0.252	−.24	0.04
		Spinal	−.050	0.022	0.075	−.10	0.00
	Spinal	Epidural	−.050	0.057	1.000	−.19	0.09
		General	0.050	0.022	0.075	0.00	0.10
APGAR score-5m	Epidural	General	0.010	0.039	1.000	−.08	0.10
		Spinal	0.026	0.038	1.000	−.07	0.12
	General	Epidural	−.010	0.039	1.000	−.10	0.08
		Spinal	0.015	0.015	0.938	−.02	0.05
	Spinal	Epidural	−.026	0.038	1.000	−.12	0.07
		General	−.015	0.015	0.938	−.05	0.02
Diclofenac sodium	Epidural	General	−.024	0.165	1.000	−.42	0.37
		Spinal	−.341	0.161	0.104	−.73	0.05
	General	Epidural	0.024	0.165	1.000	−.37	0.42
		Spinal	−.316	0.064	0.000	−.47	−.16
	Spinal	Epidural	0.341	0.161	0.104	−.05	0.73
		General	0.316	0.064	0.000	0.16	0.47
Morphine sulfate	Epidural	General	0.010	0.029	1.000	−.06	0.08
		Spinal	0.030	0.028	0.851	−.04	0.10
	General	Epidural	−.010	0.029	1.000	−.08	0.06
		Spinal	0.020	0.011	0.220	−.01	0.05
	Spinal	Epidural	−.030	0.028	0.851	−.10	0.04
		General	−.020	0.011	0.220	−.05	0.01
Pethidine HCL	Epidural	General	−.296	0.129	0.066	−.61	0.01
		Spinal	−.060	0.126	1.000	−.36	0.24
	General	Epidural	0.296	0.129	0.066	−.01	0.61
		Spinal	0.236	0.050	0.000	0.12	0.36
	Spinal	Epidural	0.060	0.126	1.000	−.24	0.36
		General	−.236	0.050	0.000	−.36	−.12
Paracetamol	Epidural	General	−.300	0.322	1.000	−1.07	0.47
		Spinal	−1.390	0.314	0.000	−2.14	−.64
	General	Epidural	0.300	0.322	1.000	−.47	1.07
		Spinal	−1.090	0.125	0.000	−1.39	−.79
	Spinal	Epidural	1.390	0.314	0.000	0.64	2.14
		General	1.090	0.125	0.000	0.79	1.39
Tramadol HCL	Epidural	General	−.0244	0.0247	0.966	−.084	0.035
		Spinal	−.0128	0.0241	1.000	−.070	0.045
	General	Epidural	0.0244	0.0247	0.966	−.035	0.084
		Spinal	0.0116	0.0096	0.671	−.011	0.035
	Spinal	Epidural	0.0128	0.0241	1.000	−.045	0.070
		General	−.0116	0.0096	0.671	−.035	0.011

Abbreviations: SD, standard deviation; Std, standard; N, number; LOS, length of stay; mL, milliliter; HCL, hydrochloride; CS, cesarean section; NICU, neonatal intensive care unit; Sig, significant.

Table 3 Comparison of Different Anesthesia Types in Relation to Different Feto-Maternal Outcomes in the Emergency Cesarean Section Category

Variables	Emergency Category
	Epidural	General	Spinal	Total	P-value
	N=314	N=278	N=659	N=1251
Age; mean (SD)	30.6 (5.5)	31.9 (5.7)	32.5 (5.6)	32 (5.7)	0.0000
LOS (days)	3.6 (2.6)	3.2 (2.1)	3.5 (2.4)	3.5 (2.4)	0.1370
Operative time (min)	43.03 (13.9)	46.4 (21.0)	44.2 (15.2)	44.4 (16.4)	0.0430
EBL (mL)	730.3 (184.7)	877.3 (709)	733.1 (213.5)	759.2 (385.0)	0.0000
Apgar-1 min	7.7 (1.1)	7.5 (1.4)	7.88 (0.67)	7.76 (0.97)	0.0000
Apgar-5 min	8.9 (0.43)	8.9 (0.68)	8.98 (0.37)	8.95 (0.47)	0.0280
Diclofenac sodium	2.1(1.7)	1.96 (1.48)	2.3 (1.9)	2.13 (1.8)	0.0420
Morphine sulphate	0.02 (0.25)	0.15 (0.47)	0.03 (0.19)	0.05 (0.294)	0.0000
Pethidine HCL	1.75 (1.53)	1.62 (1.4)	1.6 (1.4)	1.64 (1.4)	0.2810
Paracetamol	4.3 (3.2)	4.3 (4.5)	4.5 (3.5)	4.4 (3.7)	0.6350
Tramadol HCL	0.03 (0.28)	0.02 (0.16)	0.02 (0.14)	0.02 (0.19)	0.5110
Previous CS
Yes	47 (15%)	108 (38.8%)	326 (49.5%)	481 (38.4%)	0.0000
No	267 (85%)	170 (61.2%)	333 (50.5%)	770 (61.6%)
NICU admission
Yes	143 (45.5%)	130 (46.8%)	277 (42.0%)	550 (44.0%)	0.3330
No	171(54.5%)	148 (53.2%)	382 (58.0%)	701(56.0%)

Abbreviations: SD, standard deviation; N, number; LOS, length of stay; min, minute; EBL, estimated blood loss; mL, milliliter; HCL, hydrochloride; CS, cesarean section; NICU, neonatal intensive care unit.

Table 4 Multiple Comparisons Using Bonferroni Test; Emergency Category

Dependent Variables	Anesthesia	Anesthesia	Mean Difference	Std. Error	Sig.	95% Confidence Interval
						Lower Bound	Upper Bound
LOS (days)	Epidural	General	0.378	0.195	0.160	−.09	0.85
		Spinal	0.111	0.163	1.000	−.28	0.50
	General	Epidural	−.378	0.195	0.160	−.85	0.09
		Spinal	−.267	0.170	0.347	−.67	0.14
	Spinal	Epidural	−.111	0.163	1.000	−.50	0.28
		General	0.267	0.170	0.347	−.14	0.67
Age (years)	Epidural	General	−1.290	0.464	0.016	−2.40	−.18
		Spinal	−1.926	0.386	0.000	−2.85	−1.00
	General	Epidural	1.290	0.464	0.016	0.18	2.40
		Spinal	−.636	0.403	0.342	−1.60	0.33
	Spinal	Epidural	1.926	0.386	0.000	1.00	2.85
		General	0.636	0.403	0.342	−.33	1.60
Operative time (minutes)	Epidural	General	−3.328	1.350	0.042	−6.56	−.09
		Spinal	−1.131	1.124	0.945	−3.83	1.56
	General	Epidural	3.328	1.350	0.042	0.09	6.56
		Spinal	2.197	1.173	0.184	−.61	5.01
	Spinal	Epidural	1.131	1.124	0.945	−1.56	3.83
		General	−2.197	1.173	0.184	−5.01	0.61
EBL (mL)	Epidural	General	−147.083	31.300	0.000	−222.12	−72.05
		Spinal	7.190	26.063	1.000	−55.29	69.67
	General	Epidural	147.083	31.300	0.000	72.05	222.12
		Spinal	154.273	27.182	0.000	89.11	219.43
	Spinal	Epidural	−7.190	26.063	1.000	−69.67	55.29
		General	−154.273	27.182	0.000	−219.43	−89.11
APGAR score-1m	Epidural	General	0.180	0.079	0.071	−.01	0.37
		Spinal	−.155	0.066	0.056	−.31	0.00
	General	Epidural	−.180	0.079	0.071	−.37	0.01
		Spinal	−.335	0.069	0.000	−.50	−.17
	Spinal	Epidural	0.155	0.066	0.056	0.00	0.31
		General	0.335	0.069	0.000	0.17	0.50
APGAR score-5m	Epidural	General	0.048	0.039	0.654	−.05	0.14
		Spinal	−.041	0.032	0.616	−.12	0.04
	General	Epidural	−.048	0.039	0.654	−.14	0.05
		Spinal	−.089	0.034	0.026	−.17	−.01
	Spinal	Epidural	0.041	0.032	0.616	−.04	0.12
		General	0.089	0.034	0.026	0.01	0.17
Diclofenac sodium	Epidural	General	0.088	0.147	1.000	−.26	0.44
		Spinal	−.206	0.122	0.276	−.50	0.09
	General	Epidural	−.088	0.147	1.000	−.44	0.26
		Spinal	−.294	0.127	0.064	−.60	0.01
	Spinal	Epidural	0.206	0.122	0.276	−.09	0.50
		General	0.294	0.127	0.064	−.01	0.60
Morphine sulfate	Epidural	General	−.132	0.024	0.000	−.19	−.08
		Spinal	−.005	0.020	1.000	−.05	0.04
	General	Epidural	0.132	0.024	0.000	0.08	0.19
		Spinal	0.127	0.021	0.000	0.08	0.18
	Spinal	Epidural	0.005	0.020	1.000	−.04	0.05
		General	−.127	0.021	0.000	−.18	−.08
Pethidine HCL	Epidural	General	0.133	0.116	0.755	−.14	0.41
		Spinal	0.151	0.097	0.356	−.08	0.38
	General	Epidural	−.133	0.116	0.755	−.41	0.14
		Spinal	0.018	0.101	1.000	−.22	0.26
	Spinal	Epidural	−.151	0.097	0.356	−.38	0.08
		General	−.018	0.101	1.000	−.26	0.22
Paracetamol	Epidural	General	−.023	0.305	1.000	−.75	0.71
		Spinal	−.210	0.254	1.000	−.82	0.40
	General	Epidural	0.023	0.305	1.000	−.71	0.75
		Spinal	−.187	0.264	1.000	−.82	0.45
	Spinal	Epidural	0.210	0.254	1.000	−.40	0.82
		General	0.187	0.264	1.000	−.45	0.82
Tramadol HCL	Epidural	General	0.0107	0.0156	1.000	−.027	0.048
		Spinal	0.0127	0.0130	0.981	−.018	0.044
	General	Epidural	−.0107	0.0156	1.000	−.048	0.027
		Spinal	0.0021	0.0135	1.000	−.030	0.035
	Spinal	Epidural	−.0127	0.0130	0.981	−.044	0.018
		General	−.0021	0.0135	1.000	−.035	0.030

Abbreviations: SD, standard deviation; Std, standard; N, number; LOS, length of stay; mL, milliliter; HCL, hydrochloride; CS, cesarean section; NICU, neonatal intensive care unit; Std, standard; Sig, significant.

Table 5 Patients’ Satisfaction with Anesthetic Type

Satisfaction	Elective			Emergency
	Yes	No	P value	Yes	No	P value
Epidural; N (%)	1(2.70)	37(97.4)	0.000	45((37.5)	75(62.5)	0.000
General; N (%)	83(30.6)	188(69.4)		10(11.2)	79(88.8)
Epidural; N (%)	1(2.7)	37(97.4)	0.001	45(37.5)	75(62.5)	0.004
Spinal; N (%)	61(12.9)	411(87.1)		46(26.3)	129(73.7)
General; N (%)	83(30.6)	188(69.4)	0.000	10(11.2)	79(88.8)	0.004
Spinal; N (%)	61(12.9)	411(87.1)		46(26.3)	129(73.7

Abbreviations: N, number; %, percentage.