[Combined subarachnoid-epidural technique for obstetric analgesia].
Combined spinal-epidural blockade for labor pain has enjoyed increasing popularity in obstetric anesthesia. The usual procedure is to use a single space and a single needle for dural puncture, inserting a spinal needle through an epidural needle followed by insertion of a catheter. A small dose of one or several substances (usually a lipophilic opioid and a local anesthetic) is first injected in the intrathecal space to provide rapid, effective analgesia with minimal muscle blockade. The epidural catheter is used if labor lasts longer than the spinal block, if the spinal block is insufficient, or in case of cesarean section. Combined spinal-epidural blockade is a safe, valid alternative to conventional epidural analgesia and has become the main technique for providing obstetric analgesia in many hospitals. The most widely-recognized advantage of the technique is high maternal satisfaction with rapid and effective analgesia. Mobility of the lower extremities is preserved and the mother is often able to walk. Because opioids are injected into the intrathecal space and because the technique is more invasive than standard epidural analgesia, the potential risk to mother and fetus increases.
Fernández-Guisasola
J
J
Unidad de Anestesia-Reanimación, Fundación Hospital Alcorcón, Madrid. jfguisasola@fhalcorcon.es
García del Valle
S
S
Gómez-Arnau
J I
JI
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000295:instrumentation; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects / Q000494:pharmacology; D001340:Autonomic Nerve Block / Q000009:adverse effects; D001919:Bradycardia / Q000139:chemically induced; D002585:Cesarean Section; D004357:Drug Synergism; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D005315:Fetal Diseases / Q000139:chemically induced; D005318:Fetal Heart / Q000187:drug effects; D006261:Headache / Q000209:etiology; D006801:Humans; D007278:Injections, Spinal; D009325:Nausea / Q000139:chemically induced; D007744:Obstetric Labor Complications / Q000139:chemically induced; D017060:Patient Satisfaction; D011247:Pregnancy; D011537:Pruritus / Q000139:chemically induced; D012119:Respiration / Q000187:drug effects; D012306:Risk; D013346:Subarachnoid Space; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D014839:Vomiting / Q000139:chemically induced; D016138:Walking
D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D017409:Sufentanil; D005283:Fentanyl