Comparison between general, spinal, epidural, and combined spinal-epidural anesthesia for cesarean delivery: a network meta-analysis

Won Ho Kim, M. Hur, S. K. Park, S. Yoo, T. Lim, H. K. Yoon, J. T. Kim, J. H. Bahk

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2 Citations (Scopus)

Abstract

Background: This study is a network meta-analysis to compare maternal and fetal outcomes associated with four different anesthetic techniques for cesarean delivery. Methods: An arm-based, random-effects frequentist network meta-analysis was performed. A random effect model was selected considering deviance information criteria. Randomized trials reporting the following outcomes were included: Apgar score at 1- or 5-min; umbilical arterial and venous pH; umbilical arterial pH <7.2; and neonatal score at 2–4 hours. Loop-specific heterogeneity was evaluated by risk of odds ratio and τ 2 . Quality of evidence was assessed using the GRADE approach. Results: Data from 46 randomized trials including 3689 women contributed to the study. There were significant differences in Apgar score ≤6 at 1 min between spinal versus general anesthesia (odds ratio 0.27, 95% confidence interval [CI] 0.13 to 0.55: moderate quality evidence) and Apgar scores at 1- and 5-min, favoring spinal anesthesia. Umbilical venous pH associated with epidural anesthesia was significantly higher than that with general anesthesia (mean difference 0.010, 95% CI 0.001 to 0.020: moderate quality evidence) or spinal anesthesia. Spinal anesthesia was ranked best for Apgar score ≤6 at 1-min (SUCRA=89.8), Apgar score at 1-min (SUCRA=80.4) and 5-min (SUCRA=90.5). Epidural anesthesia was ranked highest for umbilical venous pH (SUCRA=87.4) and neonatal score (SUCRA=79.3). Conclusions: Spinal and epidural anesthesia were ranked high regarding Apgar scores and epidural anesthesia was ranked high regarding umbilical venous pH, but the results were based on small heterogeneous studies with high or unclear risks of bias.

Original languageEnglish
Pages (from-to)5-15
Number of pages11
JournalInternational Journal of Obstetric Anesthesia
Volume37
DOIs
StatePublished - 1 Feb 2019

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Apgar Score
Epidural Anesthesia
Spinal Anesthesia
Umbilicus
Odds Ratio
General Anesthesia
Confidence Intervals
Anesthetics
Network Meta-Analysis
Mothers

Keywords

  • Anesthesia
  • Apgar score
  • Cesarean delivery
  • Network meta-analysis

Cite this

@article{b4252b5b7b26409984ce71b577a3dc55,
title = "Comparison between general, spinal, epidural, and combined spinal-epidural anesthesia for cesarean delivery: a network meta-analysis",
abstract = "Background: This study is a network meta-analysis to compare maternal and fetal outcomes associated with four different anesthetic techniques for cesarean delivery. Methods: An arm-based, random-effects frequentist network meta-analysis was performed. A random effect model was selected considering deviance information criteria. Randomized trials reporting the following outcomes were included: Apgar score at 1- or 5-min; umbilical arterial and venous pH; umbilical arterial pH <7.2; and neonatal score at 2–4 hours. Loop-specific heterogeneity was evaluated by risk of odds ratio and τ 2 . Quality of evidence was assessed using the GRADE approach. Results: Data from 46 randomized trials including 3689 women contributed to the study. There were significant differences in Apgar score ≤6 at 1 min between spinal versus general anesthesia (odds ratio 0.27, 95{\%} confidence interval [CI] 0.13 to 0.55: moderate quality evidence) and Apgar scores at 1- and 5-min, favoring spinal anesthesia. Umbilical venous pH associated with epidural anesthesia was significantly higher than that with general anesthesia (mean difference 0.010, 95{\%} CI 0.001 to 0.020: moderate quality evidence) or spinal anesthesia. Spinal anesthesia was ranked best for Apgar score ≤6 at 1-min (SUCRA=89.8), Apgar score at 1-min (SUCRA=80.4) and 5-min (SUCRA=90.5). Epidural anesthesia was ranked highest for umbilical venous pH (SUCRA=87.4) and neonatal score (SUCRA=79.3). Conclusions: Spinal and epidural anesthesia were ranked high regarding Apgar scores and epidural anesthesia was ranked high regarding umbilical venous pH, but the results were based on small heterogeneous studies with high or unclear risks of bias.",
keywords = "Anesthesia, Apgar score, Cesarean delivery, Network meta-analysis",
author = "Kim, {Won Ho} and M. Hur and Park, {S. K.} and S. Yoo and T. Lim and Yoon, {H. K.} and Kim, {J. T.} and Bahk, {J. H.}",
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T1 - Comparison between general, spinal, epidural, and combined spinal-epidural anesthesia for cesarean delivery

T2 - a network meta-analysis

AU - Kim, Won Ho

AU - Hur, M.

AU - Park, S. K.

AU - Yoo, S.

AU - Lim, T.

AU - Yoon, H. K.

AU - Kim, J. T.

AU - Bahk, J. H.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background: This study is a network meta-analysis to compare maternal and fetal outcomes associated with four different anesthetic techniques for cesarean delivery. Methods: An arm-based, random-effects frequentist network meta-analysis was performed. A random effect model was selected considering deviance information criteria. Randomized trials reporting the following outcomes were included: Apgar score at 1- or 5-min; umbilical arterial and venous pH; umbilical arterial pH <7.2; and neonatal score at 2–4 hours. Loop-specific heterogeneity was evaluated by risk of odds ratio and τ 2 . Quality of evidence was assessed using the GRADE approach. Results: Data from 46 randomized trials including 3689 women contributed to the study. There were significant differences in Apgar score ≤6 at 1 min between spinal versus general anesthesia (odds ratio 0.27, 95% confidence interval [CI] 0.13 to 0.55: moderate quality evidence) and Apgar scores at 1- and 5-min, favoring spinal anesthesia. Umbilical venous pH associated with epidural anesthesia was significantly higher than that with general anesthesia (mean difference 0.010, 95% CI 0.001 to 0.020: moderate quality evidence) or spinal anesthesia. Spinal anesthesia was ranked best for Apgar score ≤6 at 1-min (SUCRA=89.8), Apgar score at 1-min (SUCRA=80.4) and 5-min (SUCRA=90.5). Epidural anesthesia was ranked highest for umbilical venous pH (SUCRA=87.4) and neonatal score (SUCRA=79.3). Conclusions: Spinal and epidural anesthesia were ranked high regarding Apgar scores and epidural anesthesia was ranked high regarding umbilical venous pH, but the results were based on small heterogeneous studies with high or unclear risks of bias.

AB - Background: This study is a network meta-analysis to compare maternal and fetal outcomes associated with four different anesthetic techniques for cesarean delivery. Methods: An arm-based, random-effects frequentist network meta-analysis was performed. A random effect model was selected considering deviance information criteria. Randomized trials reporting the following outcomes were included: Apgar score at 1- or 5-min; umbilical arterial and venous pH; umbilical arterial pH <7.2; and neonatal score at 2–4 hours. Loop-specific heterogeneity was evaluated by risk of odds ratio and τ 2 . Quality of evidence was assessed using the GRADE approach. Results: Data from 46 randomized trials including 3689 women contributed to the study. There were significant differences in Apgar score ≤6 at 1 min between spinal versus general anesthesia (odds ratio 0.27, 95% confidence interval [CI] 0.13 to 0.55: moderate quality evidence) and Apgar scores at 1- and 5-min, favoring spinal anesthesia. Umbilical venous pH associated with epidural anesthesia was significantly higher than that with general anesthesia (mean difference 0.010, 95% CI 0.001 to 0.020: moderate quality evidence) or spinal anesthesia. Spinal anesthesia was ranked best for Apgar score ≤6 at 1-min (SUCRA=89.8), Apgar score at 1-min (SUCRA=80.4) and 5-min (SUCRA=90.5). Epidural anesthesia was ranked highest for umbilical venous pH (SUCRA=87.4) and neonatal score (SUCRA=79.3). Conclusions: Spinal and epidural anesthesia were ranked high regarding Apgar scores and epidural anesthesia was ranked high regarding umbilical venous pH, but the results were based on small heterogeneous studies with high or unclear risks of bias.

KW - Anesthesia

KW - Apgar score

KW - Cesarean delivery

KW - Network meta-analysis

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U2 - 10.1016/j.ijoa.2018.09.012

DO - 10.1016/j.ijoa.2018.09.012

M3 - Article

C2 - 30415797

AN - SCOPUS:85056222218

VL - 37

SP - 5

EP - 15

JO - International Journal of Obstetric Anesthesia

JF - International Journal of Obstetric Anesthesia

SN - 0959-289X

ER -