title: Does epidural versus combined spinal-epidural analgesia prolong labor and increase the risk of instrumental and cesarean delivery in nulliparous women?
abstract: 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.
authors.affiliation: Department of Anesthesiology, University of Santiago de Compostela and Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Aneiros
authors.forename: Miriam
authors.initials: M
authors.lastname: Vazquez
authors.forename: Cristina
authors.initials: C
authors.lastname: Valiño
authors.forename: Manuel
authors.initials: M
authors.lastname: Taboada
authors.forename: Sergi
authors.initials: S
authors.lastname: Sabaté
authors.forename: Pablo
authors.initials: P
authors.lastname: Otero
authors.forename: Jose
authors.initials: J
authors.lastname: Costa
authors.forename: Javier
authors.initials: J
authors.lastname: Carceller
authors.forename: Rocío
authors.initials: R
authors.lastname: Vázquez
authors.forename: María
authors.initials: M
authors.lastname: Díaz-Vieito
authors.forename: Alfonso
authors.initials: A
authors.lastname: Rodríguez
authors.forename: Julian
authors.initials: J
authors.lastname: Alvarez