title: Perispinal analgesia for labour followed by patient-controlled infusion with bupivacaine and sufentanil: combined spinal-epidural vs. epidural analgesia alone.
abstract: OBJECTIVE
  Combined spinal-epidural is an alternative technique to epidural analgesia for labour, but its benefits are not clearly identified.
  
  
  METHODS
  A prospective, blinded, randomized study was undertaken involving 113 women attending a university hospital obstetric department. Analgesia was initiated with intrathecal bupivacaine 0.25% 1 mL + sufentanil 5 microg in the combined spinal-epidural group (n = 54), and with bupivacaine 0.125% + epinephrine 2.5 microg mL(-1) + sufentanil 7.5 microg in the epidural group (n = 59). In both cases this was followed by patient-controlled epidural analgesia with bupivacaine 0.125% (+ sufentanil 0.25 microg mL(-1)). Duration of labour, quality of analgesia and side-effects were compared between groups.
  
  
  RESULTS
  In the combined spinal-epidural group, the onset of analgesia was faster (5 vs. 15 min, P < 0.001), the consumption of bupivacaine was lower (7.5 vs. 11.3 mg h(-1), P = 0.003) and there was less unilateral analgesia (14.8% vs. 40.7%, P = 0.002) than in the epidural group. The characteristics of labour were similar in both groups. However, in the combined spinal-epidural group, there was a higher incidence of posterior presentation (25.9% vs. 10%, P = 0.03), pruritus (P < 0.001), hypotension (P = 0.002), somnolence (P = 0.01), nausea (P = 0.02) and one case of meningitis.
  
  
  CONCLUSIONS
  The combined spinal-epidural technique provided more effective analgesia during labour than epidural analgesia alone but offered no other advantage. It induced more adverse effects and this should be considered before routinely using the combined spinal-epidural technique.
authors.affiliation: University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France.
authors.forename: L
authors.initials: L
authors.lastname: Vernis
authors.forename: C
authors.initials: C
authors.lastname: Dualé
authors.forename: B
authors.initials: B
authors.lastname: Storme
authors.forename: J P
authors.initials: JP
authors.lastname: Mission
authors.forename: B
authors.initials: B
authors.lastname: Rol
authors.forename: P
authors.initials: P
authors.lastname: Schoeffler
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical / Q000379:methods*; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000009:adverse effects / Q000627:therapeutic use*; D002045:Bupivacaine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007746:Labor Presentation; D007743:Labor, Obstetric; D009325:Nausea / Q000139:chemically induced; D010147:Pain Measurement; D011247:Pregnancy; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced; D016037:Single-Blind Method; D012894:Sleep Stages / Q000187:drug effects; D017409:Sufentanil / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D017409:Sufentanil; D002045:Bupivacaine