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Comparison of combined spinal-epidural and low dose epidural for labour analgesia

David L. Hepner, MD^*, Robert R. Gaiser, MD, Theodore G. Cheek, MD^, and Brett B. Gutsche, MD^,

^* From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, and the
Departments of Anesthesia and
Obstetrics and Gynecology, University of Pennsylvania School of Medicine, University of Pennsylvania Health System.

Address correspondence to: David Hepner MD, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 USA. Phone: 617-732-8222; Fax: 617-277-2192; E-mail: dhepner{at}zeus.bwh.harvard.edu

Purpose: To compare the combined spinal-epidural (CSE) technique with the epidural technique with regard to time to initiate and manage, motor block, onset of analgesia and satisfaction during labour.

Methods: Upon requesting analgesia, 50 healthy term parturients were randomized in a prospective, double-blind fashion to receive either CSE analgesia or lumbar epidural analgesia in the labour floor of a university hospital at an academic medical centre. The epidural group (n=24) received bupivacaine 0.0625%-fentanyl 0.0002% with 0.05 ml in 10 ml local anesthetic sodium bicarbonate 8.4% and epinephrine 1:200, 000. The CSE group (n=26) received intrathecal 25 µg fentanyl and 2.5 mg bupivacaine. Additional analgesia was provided upon maternal request.

Results: There were no differences (P > 0.05) in time to perform either technique, motor blockade, or parturient satisfaction or in the number of times that the anesthesiologist was called to perform any intervention. Although the first sign of analgesia was not different between the two groups, the onset of complete analgesia was more rapid with the CSE technique (Visual Analogue Pain Score (VAPS) at five minutes < three: 26/26 vs 17/24, P ± 0.001).

Conclusion: Although epidural analgesia with a low concentration of local anesthetic and opioid mixture takes longer to produce complete analgesia, it is a satisfactory alternative to CSE.

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				D. J. A. Vaughan, N. Ahmad, N. K. Lillywhite, N. Lewis, D. Thomas, and P. N. Robinson Choice of opioid for initiation of combined spinal epidural analgesia in labour--fentanyl or diamorphine Br. J. Anaesth., April 1, 2001; 86(4): 567 - 569. [Abstract] [Full Text] [PDF]