Authors: Langer S. et al.
Anesthesiology, October 6, 2025. DOI: 10.1097/ALN.0000000000005785
This meta-analysis evaluated whether anesthesia type—regional (spinal, epidural, or combined spinal-epidural) versus general—affects neonatal outcomes following cesarean delivery. Despite widespread preference for regional techniques, direct evidence comparing neonatal well-being across approaches has been limited.
The authors systematically reviewed randomized controlled trials published between January 1994 and November 2023, ultimately including 36 studies encompassing 3,456 neonates. Among these, 1,980 infants were delivered under regional anesthesia and 1,476 under general anesthesia. Primary outcomes included Apgar scores at 1 and 5 minutes, need for neonatal respiratory support, and need for neonatal intensive care unit (NICU) admission. Random-effects modeling was applied, and bias was assessed using the Cochrane Risk of Bias 2 tool.
Neonates delivered under regional anesthesia had modest but statistically significant improvements in early Apgar scores—by an average of 0.58 points at 1 minute and 0.09 points at 5 minutes—compared with those exposed to general anesthesia. Additionally, regional techniques were associated with a 38% lower likelihood of requiring respiratory support after birth (risk ratio 0.62; 95% CI, 0.40–0.94; P=0.03). No significant difference was found in the rate of NICU admissions (risk ratio 0.75; 95% CI, 0.46–1.21). Most trials exhibited high or unclear bias, underscoring the need for more rigorous contemporary studies.
These findings support the continued preference for regional anesthesia in cesarean delivery due to its modest neonatal advantages, though the magnitude of effect is small and may not translate into long-term clinical benefit.
What You Should Know
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Regional anesthesia (spinal, epidural, or combined) yields slightly higher neonatal Apgar scores than general anesthesia for cesarean delivery.
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The need for neonatal respiratory support is significantly lower with regional anesthesia.
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No difference was found in NICU admission rates between techniques.
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The evidence base remains limited by study heterogeneity and potential bias.
Thank you to Anesthesiology for publishing this important synthesis comparing neonatal outcomes between regional and general anesthesia for cesarean delivery.