Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

CONTEXT AND OBJECTIVE: As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section.DESIGN AND SETTING: Prospective randomized controlled clinical trial in a tertiary-level public hospital.METHODS: Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50) and spinal anesthesia (n = 50) groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups.RESULTS: Mean bowel sounds (P = 0.036) and gas discharge time (P = 0.049) were significantly greater and 24th hour hemoglobin difference values (P = 0.001) were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24th hour (P = 0.004 and P < 0.001, respectively), urine volume at the first postoperative hour (P < 0.001) and median Apgar score at the first minute (P < 0.0005) were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042), in the spinal anesthesia group.CONCLUSION: In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account.

研究背景与目的：随着剖宫产率持续攀升，剖宫产麻醉方式的临床重要性日益凸显。本研究旨在比较全身麻醉（general anesthesia）与蛛网膜下腔麻醉（spinal anesthesia）对择期剖宫产的足月单胎妊娠产妇的母胎结局的影响。
研究设计与研究地点：于三级公立医院开展的前瞻性随机对照临床试验。
研究方法：本研究纳入100例因择期指征行剖宫产术的产妇，按随机原则分为全身麻醉组（n=50）与蛛网膜下腔麻醉组（n=50）。比较两组产妇术前及术后的血液学检测结果、术中与术后的血流动力学参数，以及围生儿结局。
研究结果：全身麻醉组患者的平均肠鸣音恢复时间（P=0.036）与首次排气时间（P=0.049）均显著更长，且术后24小时血红蛋白差值（P=0.001）更高。蛛网膜下腔麻醉组患者术后24小时的平均红细胞比容与血红蛋白水平（分别为P=0.004及P<0.001）、术后首小时尿量（P<0.001）以及新生儿出生1分钟时的Apgar评分（Apgar score）中位数（P<0.0005）均显著更高，且首次镇痛需求的间隔时间显著更长（P=0.042）。
研究结论：择期剖宫产术中，蛛网膜下腔麻醉在术后舒适度方面优于全身麻醉。对于存在胎儿窘迫风险的妊娠，结合新生儿出生1分钟Apgar评分，优先选择蛛网膜下腔麻醉更为合理。