Spinal Anesthesia and Minimal Tissue Trauma Improve the Outcome of Elective Cesarean Section

Abstract

Background: Immune balance is mandatory for proper postoperative (PO) courses and wound healing. Cesarean section is the commonest surgical procedure for females. The choice of anesthetic procedure may affect the mother and fetal outcomes. Objectives: Evaluation of the impact of general (GA) versus spinal anesthesia (SA) on parturient' cytokines' serum levels. Patients and methods: 73 and 59 parturients received GA and SA, respectively. Fetal APGAR scoring was determined at 1-min & 5-min PO. PO pain severity was evaluated using the numeric rating scale and the duration of analgesia was calculated. Blood samples (S1, S2, S3) were obtained for ELISA estimation of serum interleukins and tumor necrosis factor-α (TNF-α). The study outcome is the effect of the anesthetic procedure on serum cytokines levels. Results: Cytokines' levels were significantly higher in S2 and S3 than in S1 samples of all parturients with significantly higher levels in samples of GA patients. Percentages of change in serum cytokines' levels were higher with GA than with SA. Receiver operating characteristic (ROC) curve defined serum levels of TNF-α as the most cytokine affected by the anesthetic procedure. APGAR scores were significantly higher at 1-min and the duration of PO analgesia was significantly longer with SA. Conclusion: SA can lessen the surgery-induced release of inflammatory cytokines, while GA augments this effect. Moreover, neonatal and maternal outcomes were superior with SA than with GA.

Keywords

• general anesthesia; spinal anesthesia; cesarean section; inflammatory cytokines; surgical stress