title: Adverse effects of combined spinal-epidural versus traditional epidural analgesia during labor.
abstract: OBJECTIVE
  To compare two neuraxial block techniques during labor for maternal and fetal effects.
  
  
  METHODS
  Women in labor at term with cephalic singleton fetuses were randomized (nonblinded) to receive either labor epidural (EPI) or combined spinal-epidural (CSE) analgesia. Primary outcome was prolonged deceleration (PD) of fetal heart rate. Outcomes also included hypotension, mode of delivery, and efficacy of analgesia by visual analog pain scale (VAPS) before and after block placement.
  
  
  RESULTS
  Randomization occurred in 127 patients: 63 received EPI, 64 received CSE. There was no difference in the rate of PD in the EPI group compared with the CSE group (3.2% vs 6.2% respectively; P=0.43, RR 2.0; 95% CI 0.4-9.3), rate of cesarean delivery, or mean epidural duration. VAPS ratings were significantly lower in the CSE group.
  
  
  CONCLUSIONS
  There were no differences in the rate of PD or other adverse outcomes. Hypotension occurred more frequently with CSE during labor at term. The study supports both EPI and CSE during labor as safe and effective techniques for neuraxial analgesia.
authors.affiliation: Department of Obstetrics and Gynecology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA. dwskupsk@med.cornell.edu
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Skupski
authors.forename: Sharon
authors.initials: S
authors.lastname: Abramovitz
authors.forename: Jon
authors.initials: J
authors.lastname: Samuels
authors.forename: Vanessa
authors.initials: V
authors.lastname: Pressimone
authors.forename: Klaus
authors.initials: K
authors.lastname: Kjaer
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects* / Q000379:methods; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced; D003131:Combined Modality Therapy; D005260:Female; D006340:Heart Rate, Fetal / Q000187:drug effects*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced*; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects; D011247:Pregnancy; D012306:Risk; D055815:Young Adult