Copyright © European Society of Anaesthesiology. Unauthorized reproduction of this article is prohibited. Effects of spinal anaesthesia versus epidural anaesthesia for caesarean section on postoperative analgesic consumption and postoperative pain Jens-Christian Schewe a , Adam Komusin b , Joerg Zinserling a , Joachim Nadstawek a , Andreas Hoeft a and Rudolf Hering c Background and objective Regional anaesthesia is commonly used for elective caesarean section. The aim of this study was to investigate whether there is a positive effect of either spinal or epidural anaesthesia on postoperative analgesic requirements and pain relief. Methods The analgesic effect of either spinal or epidural induction of perispinal anaesthesia have been compared in 132 women (ASA I or II) scheduled for elective caesarean section, all having epidural catheterization for perioperative anaesthesia and postoperative analgesia. The patients were randomized into two groups. To achieve a sensory block height to the level of the sixth thoracic dermatome, the parturients received isobaric bupivacaine 0.5% and 5 mg sufentanil intrathecally or ropivacaine 0.75% and 10 mg sufentanil epidurally. For postoperative analgesia, all patients used patient-controlled epidural analgesia at identical settings [bolus of ropivacaine 0.133% (11–15 mg according to patient’s height), lock-out time 1 h]. Intraoperative and postoperative pain was recorded using a visual analogue pain score as well as analgesic requirements over the first 24 h after surgery. Results One hundred and twenty-five patients completed the study. There were no differences in patient-controlled epidural analgesic requirements between groups. During surgery, the pain score on a visual analogue scale was more intense with epidural anaesthesia than with spinal anaesthesia (P < 0.05). For the whole 24 h observation period, the area under the curve for pain was lower with spinal anaesthesia (P < 0.0005). At almost all postoperative time points, visual analogue scale scores at rest and during mobilization were lower with spinal anaesthesia (P < 0.05), which was accompanied by less motor blockade and lower frequency of adverse effects. More patients with epidural anaesthesia received supplemental analgesic medication. Conclusion In parturients undergoing elective caesarean section, postoperative use of epidural ropivacaine via patient-controlled epidural analgesia is similar after spinal and epidural anaesthesia. Spinal anaesthesia is, however, accompanied with less postoperative pain, use of additional analgesics and side-effects. Eur J Anaesthesiol 26:52–59 Q 2009 European Society of Anaesthesiology. European Journal of Anaesthesiology 2009, 26:52–59 Keywords: anaesthetic techniques, analgesia, anaesthesia, epidural, obstetrics, patient-controlled, postoperative, preemptive, spinal a Department of Anaesthesia and Intensive Care Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, b Department of Orthopaedic Surgery, St-Josef-Hospital Troisdorf, Troisdorf and c Department of Anaesthesia, Intensive Care Medicine and Pain Therapy, Kreiskrankenhaus Mechernich GmbH, Academic Teaching Hospital of Bonn University, Mechernich, Germany Correspondence to Jens-Christian Schewe, MD, Department of Anaesthesia and Intensive Care Medicine, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Street 25, 53105 Bonn, Germany Tel: +49 228 287 14218; fax: +49 228 287 14125; e-mail: jens-christian.schewe@ukb.uni-bonn.de Accepted 23 June 2008 Introduction Caesarean section is the most common surgical procedure performed in the United States [1]. Caesarean section rates currently reach 27.5% in the United States [2] and vary between 15 and 29% in Germany [3]. General anaesthesia for caesarean section has been shown to be associated with higher maternal morbidity and mortality than regional anaesthetic techniques [4]. Therefore, regional anaesthesia for caesarean section should be preferred when balancing the risks and benefits for the mother and her fetus. Both spinal anaesthesia and epi- dural anaesthesia (EDA) have been shown to provide effective anaesthesia for caesarean section [5,6]. A trend of preference for spinal anaesthesia for elective caesarean section [4,7] is, among others, thought to be due to the perceived advantages of simplicity of technique and density of spinal anaesthetic block [5]. Most of the trials comparing spinal anaesthesia and EDA for caesarean section were not randomized and focused solely on intraoperative pain [5]. Considering the concept of preemptive analgesia [8], we were interested in the effects of regional anaesthesia for caesarean section on postoperative pain. The concept of preemptive analgesia is based on experimental findings that effective analgesia initiated before the onset of surgery could prevent effects 52 Original article 0265-0215 ß 2009 Copyright European Society of Anaesthesiology DOI:10.1097/EJA.0b013e328318c639