Assessment of neonatal cerebral oxygenation using near-infrared spectroscopy in cesarean sections performed with neuraxial blocks: a prospective randomized clinical trial.

OBJECTIVE

The aim of the study was to evaluate the effects of epidural and spinal anesthesia techniques on neonatal cerebral oxygenation during cesarean surgery using near-infrared spectroscopy.

METHODS

Pregnant women aged 18-35 years, classified as American Society of Anesthesiologists (ASA) II, scheduled for elective cesarean surgery at >37 weeks of gestation, and their newborns were included. Two groups, one to receive spinal anesthesia (Group S) and the other epidural anesthesia (Group E), were determined. Appearance Pulse Grimace Acitivity Respiration (APGAR) scores, heart rates, and SpO2 values of the newborns were recorded, and umbilical venous blood gas was collected. Near-infrared spectroscopy and rSO2 (regional cerebral oxygen saturation) change percentage were measured.

RESULTS

A total of 80 patients were statistically analyzed, with 40 patients in Group S and 40 patients in Group E. Neonatal SpO2 values at 2.5 min were found to be significantly lower in Group S, while in blood gas parameters, PaO2 values were significantly lower in Group S. Near-infrared spectroscopy values at 2.5 and 5 min were significantly lower in Group S, and rSO2 change percentages were significantly lower at 2.5 min in Group S. Maternal hypotension was observed to be significantly higher in Group S (52.5%) than in Group E (22.5%). The amount of ephedrine administered until delivery was higher in Group S, but this difference was not statistically significant between the two groups.

CONCLUSION

We found significantly lower near-infrared spectroscopy values at 2.5 and 5 min and rSO2 change percentage at 2.5 min in the spinal group. We believe that epidural anesthesia has minimally more positive effects on early neonatal cerebral oxygenation compared to spinal anesthesia.