Combined spinal-epidural analgesia in advanced labour

Amr Abouleish, Ezzat Abouleish, William Camann

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

The combined spinal-epidural technique is a modification of epidural analgesia which combines the rapid onset of spinal analgesia with the flexibility of an epidural catheter. We sought to evaluate the effectiveness of an intrathecal opioid - low-dose local anaesthetic combination for parturients in advanced labour, a setting where satisfactory epidural analgesia is often difficult to achieve. The technique was evaluated in an open-label, non-randomized trial using parturients in advanced, active labour for the provision of pain relief during the late first stage and second stage of labour. Thirty-eight term parturients in active, advanced labour received a spinal injection of bu-pivacaine 2.5 mg and sufentanil, 10 μg, via a 25- or 27-gauge Whitacre needle placed into the subarachnoid space through a 17- or 18- gauge Weiss epidural needle which had been placed into the epidural space. This was followed by placement of an epidural catheter for supplemental analgesia if required. Onset of analgesia was noted by asking patients if their contractions were comfortable. Motor blockade was assessed using the Bromage criteria. Patients were asked if they experienced either pruritus or nausea on a four-point scale (none, mild, moderate, severe). The mean cervical dilatation at placement of the spinal medication was 6.1 ± 2.2 cm. Thirty-two patients had spontaneous vaginal delivery, two were delivered by outlet forceps, and four by Caesarean section. Onset of analgesia was rapid (< five minutes) in all cases. Twenty-three patients (60%) delivered vaginally with no additional anaesthetic. The remaining 15 had supplemental local anaesthetic given via the epidural catheter, a mean of 123 ± 33 min after the original spinal dose. Side effects were limited to pruritus in eight (21%) patients, and mild lower extremity motor weakness in one patient. One patient experienced transient hypotension. No patient developed postdural puncture headache. This technique allows for profound analgesia with a rapid onset and few bothersome side effects. In particular, the absence of motor blockade may facilitate maternal expulsive efforts or positioning during the second stage of labour.

Original languageEnglish (US)
Pages (from-to)575-578
Number of pages4
JournalCanadian Journal of Anaesthesia
Volume41
Issue number7
DOIs
StatePublished - Jul 1994
Externally publishedYes

Fingerprint

Epidural Analgesia
Analgesia
Second Labor Stage
Catheters
Parturition
Pruritus
Local Anesthetics
Needles
Post-Dural Puncture Headache
Labor Pain
Sufentanil
First Labor Stage
Epidural Space
Spinal Injections
Subarachnoid Space
Surgical Instruments
Cesarean Section
Hypotension
Nausea
Opioid Analgesics

Keywords

  • anaesthetic techniques: spinal, epidural
  • analgesia: obstetric
  • analgesics: sufentanil, bupivacaine

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Combined spinal-epidural analgesia in advanced labour. / Abouleish, Amr; Abouleish, Ezzat; Camann, William.

In: Canadian Journal of Anaesthesia, Vol. 41, No. 7, 07.1994, p. 575-578.

Research output: Contribution to journalArticle

Abouleish, Amr ; Abouleish, Ezzat ; Camann, William. / Combined spinal-epidural analgesia in advanced labour. In: Canadian Journal of Anaesthesia. 1994 ; Vol. 41, No. 7. pp. 575-578.
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