Does epidural versus combined spinal-epidural analgesia prolong labor and increase the risk of instrumental and cesarean delivery in nulliparous women?
OBJECTIVE
To compare duration of labor, mode of delivery, and local anesthetic consumed in women who received labor analgesia with epidural or combined spinal-epidural technique.


METHODS
Retrospective, observational study.


METHODS
Delivery room of a university hospital.


METHODS
788 nulliparous women in labor at term with cervical dilation between three and 5 cm.


METHODS
In Group E (epidural alone), parturients received an epidural solution of 8 mL (levobupivacaine 0.125% with fentanyl 5 microg/mL). In Group CSE (combined spinal-epidural), parturients received a spinal injection of levobupivacaine two mg with fentanyl 15 microg (total volume two mL). Then an epidural catheter was placed in all patients and connected to a patient-controlled analgesia pump (basal infusion rate of 8 mL/hr of 0.1% levobupivacaine and fentanyl two microg/mL, patient-controlled bolus dose of three mL, and lockout time of 30 min).


METHODS
Labor duration, mode of delivery (spontaneous vaginal vs. instrumental delivery vs. cesarean section), and local anesthetic consumed, were recorded.


RESULTS
Labor analgesia was performed with an epidural technique in 322 patients (40.9%), and a combined spinal-epidural technique in 466 patients (59.1%), of whom 39 Group E women (12.1%) and 46 Group CSE women (9.9%) required cesarean section (P=ns). No differences in the mode of delivery were observed between the groups. Time from analgesia to delivery (Group E: 217 +/- 111 min vs. Group CSE: 213 +/- 115 min; P=ns), and epidural local anesthetic consumed (Group E: 35 +/- 20 mL vs. Group CSE: 33 +/- 20 mL; P=ns), were similar in both groups.


CONCLUSIONS
No significant differences were observed between epidural and combined spinal-epidural given for labor analgesia in nulliparous women in duration of labor, mode of delivery, or local anesthetic consumed.
Aneiros
Francisco
F
Department of Anesthesiology, University of Santiago de Compostela and Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
Vazquez
Miriam
M
Valiño
Cristina
C
Taboada
Manuel
M
Sabaté
Sergi
S
Otero
Pablo
P
Costa
Jose
J
Carceller
Javier
J
Vázquez
Rocío
R
Díaz-Vieito
María
M
Rodríguez
Alfonso
A
Alvarez
Julian
J