COMPLICATIONS OF LABOR ANALGESIA - EPIDURAL VERSUS COMBINED SPINAL EPIDURAL TECHNIQUES

Both epidural and combined spinal epidural (CSE) analgesia can provide maternal pain relief during labor. Currently, there are few data comp aring the risks and complications of these two techniques. We recorded the incidence and severity of anesthetic-related complications in 102 2 laboring parturients. Ninety-eight women opted for either no or pare nteral analgesia, 388 chose epidural, and 536 requested CSE analgesia. Women choosing CSE analgesia most often received an intrathecal injec tion of sufentanil 10 mu g at the time of epidural catheter insertion. The epidural catheters were then dosed as needed as the intrathecal a nalgesia waned. Women who received CSE analgesia were more likely to i tch (41.4% vs 1.3%) or complain of nausea (2.4% vs 1.0%) or vomiting ( 3.2% vs 1.0%) than those receiving solely epidural analgesia. Patients who requested only epidural analgesia were more likely to suffer an u nintended dural puncture (4.2% vs 1.7%). Fewer than 10% developed hypo tension with either technique. The risk of headache was the same with both anesthetics (4%-10%) and did not differ from the incidence of hea dache in women not receiving neuraxial analgesia (10%-14%). Six patien ts required epidural blood patch for moderate to severe postural heada che. Four of these women suffered a dural puncture with the 18-gauge H ustead epidural needle. The other two women had reportedly uncomplicat ed epidural and CSE analgesia. These data suggest either neuraxial ana lgesic technique can safely relieve the pain of labor. CSE analgesia i s a safe alternative to epidural analgesia for labor and delivery.