Comparative Evaluation of Regional versus General Anesthesia on Maternal Hemodynamic Stability and Transfusion Requirements in Cesarean Hysterectomy for Placenta Accreta Spectrum Disorders
DOI:
https://doi.org/10.51985/Keywords:
Cesarean Section; General Anesthesia; Hemodynamic Stability; Hysterectomy; Placenta AccretaAbstract
Objectives: This study aimed to compare the effects of regional versus general anesthesia on maternal hemodynamic stability and transfusion requirements in patients undergoing cesarean hysterectomy for placenta accreta spectrum (PAS) disorders.
Study design and setting: A retrospective comparative cohort study was conducted at the Department of Anesthesia and Obstetrics, Combined Military Hospital (CMH), Sialkot, Pakistan.
Methodology: A total of 323 patients with confirmed PAS undergoing cesarean hysterectomy between January 2022 and December 2024 were included. Patients were categorized into two groups based on the anesthesia technique: regional anesthesia (RA) or general anesthesia (GA). Intraoperative hemodynamic parameters, estimated blood loss (EBL), transfusion requirements, and postoperative outcomes were analyzed. Ethical approval was obtained from the CMH ERC (Ref: ERC/43/2025), and informed consent was secured.
Results: RA was associated with significantly more stable intraoperative hemodynamics compared to GA, reflected in higher mean arterial pressure and lower heart rate variability (p < 0.05). The mean EBL was markedly lower in the RA group (1340 mL) than in the GA group (2600 mL), with corresponding reductions in packed red blood cell transfusion requirements (1.6 ± 1.2 units vs. 4.5 ± 1.5 units, p < 0.001). ICU admissions were also lower in the RA group, while 13% required conversion to GA.
Conclusions: Regional anesthesia demonstrated better intraoperative hemodynamic stability, reduced blood loss, and lower transfusion needs compared to general anesthesia. Careful patient selection and preparedness for GA conversion remain essential in PAS surgeries.
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