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Canadian Journal of Anaesthesia

, Volume 47, Issue 3, pp 232–236 | Cite as

Comparison of combined spinal-epidural and low dose epidural for labour analgesia

  • David L. Hepner
  • Robert R. Gaiser
  • Theodore G. Cheek
  • Brett B. Gutsche
Reports Of Investigation

Abstract

Purpose: To compare the combined spinal-epidural (CSE) technique with the epidural technique with regard to time to initiate and manage, motor block, onset of analgesia and satisfaction during labour.

Methods: Upon requesting analgesia, 50 healthy term parturients were randomized in a prospective, double-blind fashion to receive either CSE analgesia or lumbar epidural analgesia in the labour floor of a university hospital at an academic medical centre. The epidural group (n=24) received bupivacaine 0.0625%-fentanyl 0.0002% with 0.05 ml in 10 ml local aesthetic sodium bicarbonate 8.4% and epinephrine 1:200, 000. The CSE group (n=26) received intrathecal 25 µg fentanyl and 2.5 mg bupivacaine. Additional analgesia was provided upon maternal request.

Results: There were no differences (P>0.05) in time of perform either technique, motor blockade, or parturient satisfaction or in the number of times that the anesthesiologist was called to perform any intervention. Although the first sign of analgesia was not different between the two groups, the onset of complete analgesia was more rapid with the CSE technique (Visual Analogue Pain Score (VAPS) at five minutes<three: 26/26vs 17/24,P±0.001).

Conclusion: Although epidural analgesia with a low concentration of local anethetic and opioid mixture takes longer to produce complete analgesia, it is a satisfactory alternative to CSE.

Keywords

Bupivacaine Epidural Analgesia Motor Block Labor Analgesia Motor Blockade 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: Comparer l’analgésie rachidienne-péridurale combinée (RPC) à l’analgésie péridurale concernant le temsp nécessaire à la réalisation de la technique et à l’induction, le blocage moteur, le délai d’installation de l’analgésie et la satisfaction de la patiente pendant le travail obstétrical.

Méthode: Au moment de la demande d’analgésie, 50 parturientes à terme réparties de façon aléatoire ont reçu soit une analgésie RPC, soit une analgésie péridurale lombaire pour participer à une étude prospective en double insu. Le groupe péridural (n=24) a reçu un mélange bupivacaïne 0,0625 %-fentanyl 0,0002 % avec un ajout de 0,05 ml (par 10 ml d’anesthésique local) de bicarbonate de sodium à 8,4 % et de l’épinéphrine 1:200 000. Le groupe RPC (n=26) a reçu une injection intrathécale de 25 µg de fentanyl et de 2,5 mg de bupivacaïne. L’analgésie supplémentaire a été administrée sur demande.

Résultats: Il n’y a eu aucune différence intergroupe (P>0,05) quant au temps nécessaire à la réalisation de chacune des techniques et à l’atteinte du blocage moteur, à la satisfaction des patientes et au nombre d’interventions de l’anesthésiologiste appelé sur demande. Le premier signe d’analgésie est survenu au même temps dans les deux groupes, mais le début de l’analgésie complète est survenu plus rapidement dans le groupe RPC (Score à l’Échelle Visuelle Analogique, SEVA, à cinq minutes<trois: 26/26vs 17/24,P±0,001).

Conclusion: L’analgésie péridurale complète réalisée avec une faible concentration d’anesthésique local et un mélange d’opioïdes connaît une installation plus lente que l’analgésie RPC, mais elle en constitue une solution de remplacement satisfaisante.

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Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • David L. Hepner
    • 1
  • Robert R. Gaiser
    • 2
  • Theodore G. Cheek
    • 2
    • 3
  • Brett B. Gutsche
    • 2
    • 3
  1. 1.From the Department of Anesthesiology, Perioperative and Pain MedicineBrigham and Women’s Hospital, Harvard Medical SchoolUSA
  2. 2.the Department of AnesthesiaUniversity of Pennsylvania School of Medicine, University of Pennsylvania Health SystemUSA
  3. 3.the Department of Obstetrics and GynecologyUniversity of Pennsylvania School of Medicine, University of Pennsylvania Health SystemUSA

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