RANDOMIZED COMPARISON OF COMBINED SPINAL-EPIDURAL AND STANDARD EPIDURAL ANALGESIA IN LABOR

Epidural analgesia has a well-established role in labour, but has the drawbacks of delayed onset and motor blockade. The combined spinal-epi dural technique may overcome these drawbacks. We carried out a randomi sed observational study to assess maternal satisfaction with the stand ard and combined techniques among 197 women in labour. For combined sp inal-epidural analgesia, bupivacaine (2.5 mg) and fentanyl (25 mu g) w ere initially injected into the subarachnoid space, followed by top-up s of 15 mL 0.1% bupivacaine with 2 mu g/mL fentanyl into the epidural space, as required. For standard epidural analgesia, 25 mg (10 mL of 0 .25%) bupivacaine was injected into the epidural space, followed by to p-ups of 6-10 mL 0.25% bupivacaine, as required. Post partum, each wom an completed a questionnaire about her labour and scored various items on a visual analogue scale (0=best, 100=worst outcome). Overall satis faction was greater in the combined spinal-epidural group than in the standard epidural group (median [IQR] score 3 [2-10] vs 9 [3-22]; p=0. 0002). Good analgesia was achieved in both groups, but the combined sp inal-epidural had faster onset of analgesia and more of this group wer e satisfied with analgesia at 20 min (92/98 vs 68/99, p<0.0001). 12 wo men in the combined spinal-epidural group had leg weakness (as shown b y an inability to raise the straight legs) at 20 min, but this initial motor block had resolved in most of these mothers by 1 h. In the stan dard epidural group 32 had leg weakness at 20 min (p=0.001), and the p roportion of mothers with weakness increased in this group during labo ur. There were no differences in side-effects, except for mild pruritu s, which was more common in the combined spinal-epidural group (42 vs 1%; p<0.0001). Overall, women seem to prefer the low-dose combined spi nal-epidural technique to standard epidurals, perhaps because of the f aster onset, less motor block, and feelings of greater self-control.