Effect of combined spinal-epidural analgesia versus epidural analgesia on labor and delivery duration

Francisco Pascual-Ramirez, Javier Haya, Faustino R. Pérez-López, Silvia Gil-Trujillo, Rosa A. Garrido-Esteban, Ginés Bernal

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Objective: To determine whether combined spinal-epidural analgesia (CSEA) can decrease the known epidural effect of lengthening delivery. Methods: Between April and May 2010, 144 women undergoing childbirth in hospital with epidural pain relief were randomized to receive either low-dose epidural analgesia (LEA) or CSEA. The spinal component included 2.5 mg of bupivacaine, 25 μg of fentanyl, and 200 μg of morphine. The epidural component of the CSEA procedure was started once pain returned. The primary outcome was total labor duration measured from the time of initiation of labor analgesia to delivery. Results: The difference in duration between LEA (n = 72) and CSEA (n = 72) was 5 minutes for labor (P = 0.82), 2 minutes for delivery (P = 0.60), and 7 minutes for total labor duration (P = 0.75). The combined group used less levobupivacaine (P < 0.001) and had lower sensory blockade at the dermatomal level (P = 0.037). Women in the CSEA group had a higher incidence of pruritus (P = 0.002) and lightheadedness (P = 0.02) during labor; and a higher incidence of pruritus (P = 0.002), nausea-vomiting (P = 0.026), and drowsiness (P = 0.003) in the postpartum period. Conclusion: As compared with LEA, CSEA did not shorten the duration of labor length; however, it did reduce levobupivacaine consumption and motor weakness.

Original languageEnglish (US)
Pages (from-to)246-250
Number of pages5
JournalInternational Journal of Gynecology and Obstetrics
Volume114
Issue number3
DOIs
StatePublished - Jan 1 2011
Externally publishedYes

Keywords

  • Combined spinal-epidural analgesia
  • Labor and delivery duration
  • Labor epidural analgesia
  • Morphine spinal analgesia
  • Randomized trial

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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