[Comparison of 2 techniques for combined spinal-epidural analgesia for advanced labor in childbirth].
OBJECTIVE
To assess whether using a needle-locking device in combined spinal-epidural analgesia leads to better quality of pain relief for advanced stages of obstetric labor than can be achieved with conventional materials.


METHODS
A total of 230 women in advanced labor were randomized to 2 groups. In both groups the needle-through-needle technique was used. In group N we used a new technique with a Tuohy needle and a system for locking the spinal needle (27-gauge, pencil-point design). The conventional technique (group C) made use of the same Tuohy needle and spinal needle without the needle-locking device. The variables considered were patient characteristics, anesthesiologist, number of attempts and level of difficulty in carrying out the procedure, pain on a simple verbal visual analog scale before the procedure and 5 minutes later, latency, motor block, duration of spinal analgesia, complications, type of expulsion, and maternal satisfaction.


RESULTS
The 2 groups were similar with respect to all studied variables except duration of spinal analgesia (longer in group N, P<0.001); VAS after 5 minutes (lower in group N, P<0.010); latency (shorter in group N, P<0.001); lateralization (less in group N, P=0.034), and maternal satisfaction (greater in group N, P=0.037).


CONCLUSIONS
The use of devices specifically designed for administering combined spinal-epidural analgesia in advanced stages of labor provides faster pain relief, longer duration of analgesia, and greater maternal satisfaction without increasing the incidence of complications.
Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Hospital Maternal, Madrid. enriquecanser@hotmail.com
E
E
Canser
B
B
Martínez
E
E
Gredilla
F J
FJ
Palacio
E
E
Alonso
I
I
Fornet
F
F
Gilsanz
D015360:Analgesia, Epidural / Q000295:instrumentation*; D016362:Analgesia, Obstetrical / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006801:Humans; D009339:Needles; D011247:Pregnancy