A Randomized Controlled Comparison of Epidural Analgesia and Combined Spinal-Epidural Analgesia in a Private Practice Setting

Abstract

Compared with traditional epidural labor analgesia, CSE analgesia provided better first-stage analgesia despite fewer epidural top-up injections by an anesthesiologist.

Combined spinal-epidural analgesia for laboring parturients in a Nigerian Hospital

“…[4][5][6][7] Apart from rapid onset analgesia, a high proportion (90%) experienced adequate analgesia that is congruous with the findings of other workers. [7][8][9][10] We had more nulliparous than parous patients requesting for CSE in contrast with Miro et al data, [7] understandably, a high proportion (62%) of our cohort received oxytocin augmentations causing extreme pain situations. We suggest that CSE can be safely used in every laboring parturient irrespective of parity either in early or late labor situations.…”

“…Some authors have opined that the local anesthetic dose has a telling effect on the delivery outcome hence low-dose regimens are promoted over the past 10-15 years because higher doses cause more motor block, prolong first and second stages of labor and increase instrumental/cesarean delivery. [7][8][9]12] On neonatal outcome, the mean 1-min and 5-min Apgar scores were 8.1 and 9.7 respectively, which were satisfactory in the absence of cord blood gas analysis. Only minor and easily treatable side effects such as vomiting and shivering were documented in our study population.…”

Analgesia for Childbirth: Modern Insights Into an Age-Old Challenge and the Quest for an Ideal Approach

“…CSE analgesia produces rapid anti nociception through the initial effect of intra thecal lipophilic opioids on spinal cord opioid receptors, with or without the effect of a very small dose of local anesthetic on the unsheathed nerve roots of the cauda equina. Compared with epidural analgesia alone, excellent pain relief occurs within 5-10 min (vs 10-20 min), irre spective of the stage of labor; and motor block is absent or minimal initially [71][72][73][74]. It also reduces the requirement for subsequent epidural bolus doses [74].…”

“…Compared with epidural analgesia alone, excellent pain relief occurs within 5-10 min (vs 10-20 min), irre spective of the stage of labor; and motor block is absent or minimal initially [71][72][73][74]. It also reduces the requirement for subsequent epidural bolus doses [74]. Maternal satisfaction is high, despite more pruritus [69,71].…”

“…Research into the optimal maintenance epi dural regimens has explored various drug com binations, involving opioids, local anesthetics, aadrenergic agonists (clonidine and dexme detomidine) and acetylcholinesterase inhibitors (neostigmine) [11,65,74]. Mean local anesthetic volume and concentration studies suggest that at least two drugs should be combined and that larger volumes of lower concentration solution have dosesparing effects [11,70].…”