Combined spinal-epidural versus epidural labor analgesia

Abstract

Background: Despite the growing popularity of combined spinal - epidural analgesia in laboring women, the exact role of intrathecal opioids and the needle-through-needle technique remains to be determined. The authors hypothesized that anesthetic technique would have little effect on obstetric outcome or anesthetic complications. Methods: Data were prospectively collected from 2,183 laboring women randomly assigned to have labor analgesia induced with either 10 μg intrathecal sufentanil with or without 2.0 mg bupivacaine (n=1,071) or 10-g epidural sufentanil and 12.5-25.0 mg bupivacaine (n=1,112). Immediately after induction, a continuous epidural infusion of 0.083% bupivacaine pins 0.3 μg/ml sufentanil was begun in all patients and continued until delivery. Labor was managed by nurses, obstetricians, and obstetric residents who were unaware of the anesthetic technique used. Results: Anesthetic technique lacked impact on our primary outcome: mode of delivery or labor duration. Infants whose mothers were allocated to the combined spinal - epidural group had a slightly higher umbilical artery carbon dioxide partial pressure (54.2±10.4 vs. 53.2±10.2 mmHg). However, only achieving at least 5 cm cervical dilation before induction of analgesia and having a cesarean delivery were independent risk factors for elevated umbilical artery carbon dioxide partial pressure. The frequencies of accidental dural puncture, failed epidural analgesia, headache, and epidural blood patch were low and similar in the two groups. Conclusions: Labor progress and outcome are similar among women receiving either combined spinal-epidural or epidural analgesia. The difference in neonatal outcome appears related to the presence of confounding variables. The combined spinal-epidural technique is not associated with an increased frequency of anesthetic complications. Either technique can safely provide effective labor analgesia.