Comparison of combined spinal-epidural and low dose epidural for labour analgesia.
OBJECTIVE
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 microg 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).


CONCLUSIONS
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.
Hepner
D L
DL
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. dhepner@zeus.bwh.harvard.edu
Gaiser
R R
RR
Cheek
T G
TG
Gutsche
B B
BB
D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002021:Buffers; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D004837:Epinephrine; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007278:Injections, Spinal; D009046:Motor Neurons / Q000187:drug effects; D009407:Nerve Block; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement; D017060:Patient Satisfaction; D011247:Pregnancy; D011446:Prospective Studies; D017693:Sodium Bicarbonate; D013997:Time Factors; D014662:Vasoconstrictor Agents
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002021:Buffers; D014662:Vasoconstrictor Agents; D017693:Sodium Bicarbonate; D005283:Fentanyl; D002045:Bupivacaine; D004837:Epinephrine