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Perispinal analgesia for labour followed by patient-controlled infusion with bupivacaine and sufentanil: combined spinal–epidural vs. epidural analgesia alone

Published online by Cambridge University Press:  23 December 2004

L. Vernis ,
C. Dualé ,
B. Storme ,
J. P. Mission ,
B. Rol  and
P. Schoeffler
L. Vernis
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France
C. Dualé
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France
B. Storme
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France
J. P. Mission
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France
B. Rol
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France
P. Schoeffler
Affiliation:
University Hospital, Department of Anaesthesia and Intensive Care, CHU de Clermont-Ferrand, France
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Abstract

Summary

Background and objective: Combined spinal–epidural is an alternative technique to epidural analgesia for labour, but its benefits are not clearly identified.

Methods: A prospective, blinded, randomized study was undertaken involving 113 women attending a university hospital obstetric department. Analgesia was initiated with intrathecal bupivacaine 0.25% 1 mL + sufentanil 5 μg in the combined spinal–epidural group (n = 54), and with bupivacaine 0.125% + epinephrine 2.5 μg mL−1 + sufentanil 7.5 μg in the epidural group (n = 59). In both cases this was followed by patient-controlled epidural analgesia with bupivacaine 0.125% (+sufentanil 0.25 μg mL−1). Duration of labour, quality of analgesia and side-effects were compared between groups.

Results: In the combined spinal–epidural group, the onset of analgesia was faster (5 vs. 15 min, P < 0.001), the consumption of bupivacaine was lower (7.5 vs. 11.3 mg h−1, P = 0.003) and there was less unilateral analgesia (14.8% vs. 40.7%, P = 0.002) than in the epidural group. The characteristics of labour were similar in both groups. However, in the combined spinal–epidural group, there was a higher incidence of posterior presentation (25.9% vs. 10%, P = 0.03), pruritus (P < 0.001), hypotension (P = 0.002), somnolence (P = 0.01), nausea (P = 0.02) and one case of meningitis.

Conclusions: The combined spinal–epidural technique provided more effective analgesia during labour than epidural analgesia alone but offered no other advantage. It induced more adverse effects and this should be considered before routinely using the combined spinal–epidural technique.

Keywords

ANALGESIA, OBSTETRICAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 3 , March 2004 , pp. 186 - 192
Copyright
2004 European Society of Anaesthesiology

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