Labor analgesia: a comparative study between combined spinal-epidural anesthesia versus continuous epidural anesthesia.
OBJECTIVE
Pain relief during labor is a permanent concern, aiming at the maternal well being, decreasing the stress secondary to pain, and reducing its consequences on the fetus. Several analgesia techniques can be used during labor. The aim of this study was to compare continuous and combined epidural analgesia, both of them using 0.25% bupivacaine with 50% enantiomeric excess and fentanyl.


METHODS
Forty pregnant women, in labor, with cervical dilation between 4 and 5 cm, were randomly divided in two groups. Group I received continuous epidural anesthesia. Group II received combined anesthesia. The following parameters were evaluated: anthropometric measurements, gestational age, cervical dilation, length of time between the blockade and absence of pain according to the visual analogic scale, ability to walk, length of time between analgesia and complete cervical dilation, duration of the expulsive phase, maternal hemodynamic parameters, and vitality of the newborn. Possible complications, such as respiratory depression, maternal hypotension, pruritus, nausea, and vomiting were also evaluated. The Student t test was used to compare the means and the Chi-square test was used to compare the number of pregnancies and type of labor.


RESULTS
There were no statistically significant differences between both groups regarding the length of time between the beginning of analgesia and complete cervical dilation, as well as regarding the duration of the expulsive phase, incidence of cesarean section related to the analgesia, maternal hemodynamic parameters, and vitality of the newborn.


CONCLUSIONS
Both techniques are effective and safe for labor analgesia, although the combined technique provided fast and immediate pain relief. Clinical studies with a larger number of patients are necessary to evaluate the differences in the incidence of cesarean sections.
Côrtes
Carlos Alberto de Figueiredo
CA
Hospital e Maternidade de Campinas, CET/SBA Integrado de Campinas, Campinas, SP. secan@terra.com.br
Sanchez
Cândido Amaral
CA
Oliveira
Amaury Sanchez
AS
Sanchez
Fernando Martinez
FM