Which is safer: A traditional epidural or a combined spinal epidural?

Abstract

A 32-year-old primigravida at 5-cm dilatation, with regular contractions and intact membranes, is admitted to the labor floor in active labor. She is obese (body mass index [BMI] 41) and has a Mallampati class III airway. The rest of her medical history is unremarkable. After addressing her questions and concerns and signing consent, you perform a traditional epidural with loss of resistance to air, 6 cm from the skin. Aspiration and test dose are negative. The epidural catheter is loaded with 10 ml bupivacaine, 0.125 %, and fentanyl, 50 µ(mu)g. Patient-controlled epidural analgesia with both continuous and demand dosing is initiated before you leave the room.