Combined spinal epidural analgesia is the preferred technique for labour analgesia.
To justify its place as the preferred method of pain relief in labour, CSE must demonstrated a clear superiority over epidural analgesia. Looking at the relative efficacy of the two techniques failure rates appear to be equal. Speed of onset may be faster with an initial spinal injection although perhaps only clinically relevant in advanced labour where the quality of analgesia may sometimes be better. CSE would not seem to offer significant advantage in terms of mode of delivery or the ability to ambulate. The side effects of the technique are somewhat more concerning as CSE would appear to carry slightly greater risk than epidural analgesia, most notably in neurological sequelae and the effects of intrathecal opioids. Certainly CSE confers no benefit in terms of cost. What then is the place of CSE in labour analgesia? Its potential benefit makes it a reasonable option when there is a clear clinical advantage such as requests for analgesia in late labour or where maternal distress is extreme or where epidural analgesia has been ineffective. However even in such situations the slight increase in risk must be weighed against the possible advantage. Consequently the CSE cannot at the present time be recommended as the preferred option for labour analgesia.
Russell
R
R
Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK.
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000191:economics; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000191:economics; D000701:Analgesics, Opioid / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000191:economics; D000777:Anesthetics / Q000009:adverse effects; D004434:Early Ambulation; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D007743:Labor, Obstetric; D008581:Meningitis / Q000209:etiology; D011247:Pregnancy; D013119:Spinal Cord Injuries / Q000209:etiology; D013129:Spinal Puncture
D000701:Analgesics, Opioid; D000777:Anesthetics