Epidural anesthesia and postoperative control of arterial pressure in patients with serious preeclampsia and who have undergone cesarean section

Abstract

Introduction: Preeclampsia in Cuba has an incidence of 10 to 12 and a neonatal mortality of 35%. There is little evidence about the standard treatment. The use of epidural anesthesia in severe preeclampsia is accepted because, among other benefits, it stabilizes blood pressure.
Objective: To evaluate the effectiveness of continuous epidural anesthesia as an adjuvant in the postoperative control of blood pressure in patients with severe preeclampsia.
Method: An experimental study was performed at Dr. Agostinho Neto Hospital in the period 2013-2016. We included 180 pregnant women aged 15-40 and with severe preeclampsia undergoing cesarean section (ASA III), randomly assigned to a study group and a control group. In both cases, we used the Cuban obstetrical standard for treating preeclampsia. The control group received postoperative analgesia according to the recommendations of the hospital protocol, while continuous epidural anesthesia was used with 12.5 mg/h of bupivacaine 0.125 % in the study group. Systolic, diastolic and mean arterial pressure were measured during the first eight postoperative hours.
Results: Systolic and diastolic blood pressure was controlled in 93 % and 88 %, respectively. In the control group, 47 % needed three antihypertensive drugs, while 6 % evolved towards eclampsia. Symptoms were controlled in 97 % of the study group. Tachycardia was the most common expected side effect of epidural anesthesia.
Conclusions: Epidural anesthesia with 12.5 mg/h of bupivacaine is effective as an adjuvant in controlling postoperative blood pressure in patients with severe preeclampsia.