Comparison of Segmental versus Conventional Spinal Anaesthesia in Preeclamptic Parturient Undergoing Caesarean Section: A Randomised Controlled Study

Introduction: Spinal anaesthesia-induced maternal hypotension is still the most frequent complication observed in preeclamptic parturient. Segmental spinal anaesthesia is another alternative where the dural puncture is done at the lower thoracic vertebral level, and segments involving the surgical interventions are blocked preferentially. Aim: To compare haemodynamic variables and sensory and motor blockade characteristics after segmental versus conventional spinal anaesthesia in preeclamptic parturients undergoing Lower-Segment Caesarean Section (LSCS). Materials and Methods: The present randomised controlled study was conducted at Baroda Medical College, Sir Sayajirao General Hospital, Vadodara, Gujarat, India, from July 2022 to August 2023. A total of 70 preeclamptic parturients with American Society of Aanaesthesiologists (ASA) status II and III, posted for caesarean section, were randomly allocated to either Group S, which received segmental spinal anaesthesia at the T9-10 or T10-11 level, or Group C, which received conventional spinal anaesthesia at the L2-3 or L3-4 level. The primary parameter studied was a comparison of haemodynamic stability. Characteristics of sensory and motor blockade, ability to go to stretcher unaided, duration of postoperative analgesia, and perioperative complications were observed secondarily. Pearson’s χ2-test, student t-test and Mann-Whitney U test were applied as appropriate for the final statistical analysis. The significance of data analysed by p-value and p<0.05 was considered significant. Results: The mean age and ASA status of the patients were comparable in Group S and Group C. (25.88±5.36 vs 25.36±4.89, p=0.72 and 18/17 vs 16/19, p=0.68, respectively). Reduced incidences of hypotension (14.29% vs 37.14%, p=0.03) leading to the requirement of a lesser number of doses of vasopressor in patients with Group S than in Group C (0 (0-0 vs 0 (0-1), p=0.02). The onset of sensory blockade at the T6 dermatome was faster (69.2±72.65 vs 200.4±134.92 seconds, p<0.0001), and the duration of sensory blockade was shorter in patients belonging to Group S in comparison to Group C (123.6±55.66 vs 203.8±45.71 minutes, p<0.0001). All patients in Group C had grade three motor blockade as opposed to none in Group S (p<0.0001), which led most (90%) of patients in Group S to shift to the stretcher unaided. Conclusion: Segmental spinal anaesthesia is a safe and alternative technique when used in a preeclamptic parturient undergoing LSCS, providing better haemodynamic stability with adequate anaesthesia and early postoperative ambulation.