[Obstetric analgesia: peridural analgesia versus combined spinal and peridural analgesia].
OBJECTIVE
To compare the analgesic efficiency, side effects and obstetrical repercussions of epidural analgesia (EP) and combined spinal-epidural analgesia (CSE).


METHODS
Prospective, randomized, double or single-blind studies as required, approved by the ethical committee of the institution.


METHODS
The study included 80 parturients, in active labour with a singleton in vertex presentation and a cervical dilatation of 3 cm or less, randomly allocated to receive either EP (n = 40) or CSE (n = 40).


METHODS
In the EP group, sufentanil (20 micrograms) and 0.25% bupivacaine (6-8 mL) were injected into the epidural space. In those of the CSE group, sufentanil (10 micrograms) was first injected into the subarachnoid space, followed by an epidural injection of the same agents at the same quantities as for the EP group. Additional analgesia was obtained in both groups by top-ups of 6-8 mL of 0.25% bupivacaine at the request of the patients. Analgesia, course of labour, obstetrical outcome, and neonatal status were assessed. Statistical analysis was performed using Anova, chi 2 analysis, Yates' correction or Fisher's exact test, with a P < 0.05 considered as significant.


RESULTS
Both groups had similar demographic and obstetric data. The onset of analgesia was more rapid in CSE group (8 +/- 11 min vs. 12 +/- 7 min, P < 0.05), however the duration was similar. Technical incidents were more frequent in the CSE group (30% vs. 7%, P < 0.05). The technique of analgesia did not influence the bupivacaine amounts required for its maintenance. The incidence of adverse effects were comparable with the exception of vertigo, which was more frequent in the EP group (57% vs. 28%, P < 0.05). The first stage of labour was increased by 30% in the CSE group (281 +/- 130 min vs. 216 +/- 97 min, P < 0.05), without significant prolongation of labour length. Durations of second stage and expulsion were similar in both groups, despite the administration of a lower dose of bupivacaine in the CSE group (33 +/- 17 mg vs. 46 +/- 12 mg, P < 0.05). The rates of instrumental deliveries and Caesarien sections were comparable. The Apgar scores were satisfactory at 5 min.


CONCLUSIONS
In the early phase of labour, the CSE technique using intrathecal sufentanil has no significant benefit when compared to the EP technique using bupivacaine and sufentanil. In the CSE group, technical incidents were more frequent and the length of the first stage of labour was increased.
Roux
M
M
Service d'anesthésie-réanimation, clinique universitaire P-Gellé, Roubaix, France.
Wattrisse
G
G
Tai
R B
RB
Dufossez
F
F
Krivosic-Horber
R
R
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D002045:Bupivacaine; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007278:Injections, Spinal; D011247:Pregnancy; D011446:Prospective Studies; D017409:Sufentanil
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D017409:Sufentanil; D002045:Bupivacaine
Analgésie obstétricale: analgésie péridurale versus analgésie rachidienne et péridurale combinée.