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Perispinal analgesia for labour followed by patient-controlled infusion with bupivacaine and sufentanil: combined spinal–epidural vs. epidural analgesia alone

Published online by Cambridge University Press:  23 December 2004

L. Vernis ,
C. Dualé ,
B. Storme ,
J. P. Mission ,
B. Rol  and
P. Schoeffler
L. Vernis
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France
C. Dualé
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France
B. Storme
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France
J. P. Mission
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France
B. Rol
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France
P. Schoeffler
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France
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Abstract

Summary

Background and objective: Combined spinal–epidural is an alternative technique to epidural analgesia for labour, but its benefits are not clearly identified.

Methods: A prospective, blinded, randomized study was undertaken involving 113 women attending a university hospital obstetric department. Analgesia was initiated with intrathecal bupivacaine 0.25% 1 mL + sufentanil 5 μg in the combined spinal–epidural group (n = 54), and with bupivacaine 0.125% + epinephrine 2.5 μg mL−1 + sufentanil 7.5 μg in the epidural group (n = 59). In both cases this was followed by patient-controlled epidural analgesia with bupivacaine 0.125% (+sufentanil 0.25 μg mL−1). Duration of labour, quality of analgesia and side-effects were compared between groups.

Results: In the combined spinal–epidural group, the onset of analgesia was faster (5 vs. 15 min, P < 0.001), the consumption of bupivacaine was lower (7.5 vs. 11.3 mg h−1, P = 0.003) and there was less unilateral analgesia (14.8% vs. 40.7%, P = 0.002) than in the epidural group. The characteristics of labour were similar in both groups. However, in the combined spinal–epidural group, there was a higher incidence of posterior presentation (25.9% vs. 10%, P = 0.03), pruritus (P < 0.001), hypotension (P = 0.002), somnolence (P = 0.01), nausea (P = 0.02) and one case of meningitis.

Conclusions: The combined spinal–epidural technique provided more effective analgesia during labour than epidural analgesia alone but offered no other advantage. It induced more adverse effects and this should be considered before routinely using the combined spinal–epidural technique.

Keywords

ANALGESIA, OBSTETRICAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 3 , March 2004 , pp. 186 - 192
Copyright
2004 European Society of Anaesthesiology

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References

Chestnut DH, Owen CL, Bates JN, Ostman LG, Choi WW, Geiger MW. Continuous infusion epidural analgesia during labor: a randomized, double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine. Anesthesiology 1988; 68: 754–759.Google Scholar
Beilin Y, Leibowitz AB, Bernstein HH, Abramovitz SE. Controversies of labor epidural analgesia. Anesth Analg 1999; 89: 969–978.Google Scholar
Collis RE, Baxandall ML, Srikantharajah ID, Edge G, Kadim MY, Morgan BM. Combined spinal epidural analgesia with ability to walk throughout labour. Lancet 1993; 341: 767–768.Google Scholar
Campbell DC, Camann WR, Datta S. The addition of bupivacaine to intrathecal sufentanil for labor analgesia. Anesth Analg 1995; 81: 305–309.Google Scholar
Collis RE, Davies DW, Aveling W. Randomised comparison of combined spinal–epidural and standard epidural analgesia in labour. Lancet 1995; 345: 1413–1416.Google Scholar
Tsen LC, Thue B, Datta S, Segal S. Is combined spinal–epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia? Anesthesiology 1999; 91: 920–925.Google Scholar
Nageotte MP, Larson D, Rumney PJ, Sidhu M, Hollenbach K. Epidural analgesia compared with combined spinal–epidural analgesia during labor in nulliparous women. New Engl J Med 1997; 337: 1715–1719.Google Scholar
Chestnut DH, Laszewski LJ, Pollack KL, Bates JN, Manago NK, Choi WW. Continuous epidural infusion of 0.0625% bupivacaine–0.0002% fentanyl during the second stage of labor. Anesthesiology 1990; 72: 613–618.Google Scholar
Norris MC, Grieco WM, Borkowski M, et al. Complications of labor analgesia: epidural versus combined spinal epidural techniques. Anesth Analg 1994; 79: 529–537.Google Scholar
Norris MC, Fogel ST, Holtmann B. Intrathecal sufentanil (5 vs. 10 microg) for labor analgesia: efficacy and side effects. Reg Anesth Pain Med 1998; 23: 252–257.Google Scholar
Cohen SE, Cherry CM, Holbrook JrRH, el-Sayed YY, Gibson RN, Jaffe RA. Intrathecal sufentanil for labor analgesia – sensory changes, side effects, and fetal heart rate changes. Anesth Analg 1993; 77: 1155–1160.Google Scholar
Mardirosoff C, Dumont L, Boulvain M, Tramèr MR. Fetal bradycardia due to intrathecal opioids for labour analgesia: a systematic review. BJOG 2002; 109: 274–281.Google Scholar
Cascio M, Heath G. Meningitis following a combined spinal–epidural technique in a labouring term parturient. Can J Anesth 1996; 43: 399–402.Google Scholar
Harding SA, Collis RE, Morgan BM. Meningitis after combined spinal-extradural anaesthesia in obstetrics. Br J Anaesth 1994; 73: 545–547.Google Scholar
Kartawiadi L, Vercauteren MP, Van Steenberge AL, Adriaensen HA. Spinal analgesia during labor with low-dose bupivacaine, sufentanil, and epinephrine. A comparison with epidural analgesia. Reg Anesth 1996; 21: 191–196.Google Scholar
Price C, Lafreniere L, Brosnan C, Findley I. Regional analgesia in early active labour: combined spinal epidural vs. epidural. Anaesthesia 1998; 53: 951–955.Google Scholar
Dresner M, Bamber J, Calow C, Freeman J, Charlton P. Comparison of low-dose epidural with combined spinal–epidural analgesia for labour. Br J Anaesth 1999; 83: 756–760.Google Scholar
Hepner DL, Gaiser RR, Cheek TG, Gutsche BB. Comparison of combined spinal–epidural and low dose epidural for labour analgesia. Can J Anesth 2000; 47: 232–236.Google Scholar
Gambling DR, Huber CJ, Berkowitz J, et al. Patient-controlled epidural analgesia in labour: varying bolus dose and lockout interval. Can J Anesth 1993; 40: 211–217.Google Scholar
Ferrante FM, Rosinia FA, Gordon C, Datta S. The role of continuous background infusions in patient-controlled epidural analgesia for labor and delivery. Anesth Analg 1994; 79: 80–84.Google Scholar
Curry PD, Pacsoo C, Heap DG. Patient-controlled epidural analgesia in obstetric anaesthetic practice. Pain 1994; 57: 125–127.Google Scholar
Gambling DR, Sharma SK, Ramin SM, et al. A randomized study of combined spinal–epidural analgesia versus intravenous meperidine during labor: impact on cesarean delivery rate. Anesthesiology 1998; 89: 1336–1344.Google Scholar
Roux M, Wattrisse G, Subtil D, et al. A comparison of early combined spinal epidural analgesia versus epidural analgesia on labor stage duration and obstetric outcome. Anesthesiology 1996; 85: A851.Google Scholar
Herman NL, Calicott R, Van Decar TK, Conlin G, Tilton J. Determination of the dose-response relationship for intrathecal sufentanil in laboring patients. Anesth Analg 1997; 84: 1256–1261.Google Scholar
Abouleish A, Abouleish E, Camann W. Combined spinal–epidural analgesia in advanced labour. Can J Anesth 1994; 41: 575–578.Google Scholar
Viscomi CM, Rathmell JP, Mason SB, Livermore M, Schapiro H. Analgesic efficacy and side effects of subarachnoid sufentanil–bupivacaine administered to women in advanced labor. Reg Anesth 1996; 21: 424–429.Google Scholar