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Canadian Journal of Anesthesia, Vol 41, 575-578, Copyright © 1994 by Canadian Anesthesiologists' Society

ARTICLES

Combined spinal-epidural analgesia in advanced labour

A Abouleish, E Abouleish and W Camann
Department of Anesthesia, Brigham and Women's Hospital, Boston, MA 02115.

The combined spinal-epidural technique is a modification of epidural analgesia which combines the rapid onset of spinal analgesia with the flexibility of an epidural catheter. We sought to evaluate the effectiveness of an intrathecal opioid--low-dose local anaesthetic combination for parturients in advanced labour, a setting where satisfactory epidural analgesia is often difficult to achieve. The technique was evaluated in an open-label, non-randomized trial using parturients in advanced, active labour for the provision of pain relief during the late first stage and second stage of labour. Thirty-eight term parturients in active, advanced labour received a spinal injection of bupivacaine 2.5 mg and sufentanil, 10 micrograms, via a 25- or 27-gauge Whitacre needle placed into the subarachnoid space through a 17- or 18-gauge Weiss epidural needle which had been placed into the epidural space. This was followed by placement of an epidural catheter for supplemental analgesia if required. Onset of analgesia was noted by asking patients if their contractions were comfortable. Motor blockade was assessed using the Bromage criteria. Patients were asked if they experienced either pruritus or nausea on a four-point scale (none, mild, moderate, severe). The mean cervical dilatation at placement of the spinal medication was 6.1 +/- 2.2 cm. Thirty-two patients had spontaneous vaginal delivery, two were delivered by outlet forceps, and four by Caesarean section. Onset of analgesia was rapid (< five minutes) in all cases. Twenty-three patients (60%) delivered vaginally with no additional anaesthetic. The remaining 15 had supplemental local anaesthetic given via the epidural catheter, a mean of 123 +/- 33 min after the original spinal dose.(ABSTRACT TRUNCATED AT 250 WORDS)


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 Canadian J. AnesthesiaHome page
R. Preston
The role of combined spinal epidural analgesia for labour: is there still a question?/Le role de l'analgesie rachidienne-peridurale combinee pour le travail obstetrical : y a-t-il encore une question ?
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M. J. Paech, S. L. Banks, L. C. Gurrin, S. T. Yeo, and T. J. G. Pavy
A Randomized, Double-Blinded Trial of Subarachnoid Bupivacaine and Fentanyl, With or Without Clonidine, for Combined Spinal/Epidural Analgesia During Labor
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 Canadian J. AnesthesiaHome page
A. Abouleish, D Portnoy, and E. Abouleish
Addition of dextrose 3.5% to intrathecal sufentanil for labour analgesia reduces pruritis
Can J Anesth, December 1, 2000; 47(12): 1171 - 1175.
[Abstract]


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Copyright © 1994 by the Canadian Anesthesiologists' Society.