Adverse effects of combined spinal-epidural versus traditional epidural analgesia during labor

Skupski, Daniel; Abramovitz, Sharon; Samuels, Jon D.; Pressimone, Vanessa J.; Kjaer, Klaus

doi:10.1016/j.ijgo.2009.04.019

Cited by 27 publications

(16 citation statements)

References 18 publications

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“…). After the inclusion criteria were applied and hand searches completed, 40 eligible RCTs remained . The details of these RCTs are reported in Appendix S1, and the results of the RCTs are summarised in Tables and .…”

Section: Resultsmentioning

confidence: 99%

Prevention of post‐dural puncture headache in parturients: a systematic review and meta‐analysis

Bradbury

Singh

Badder

et al. 2012

Acta Anaesthesiol Scand

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Post-dural puncture headaches (PDPHs) present an important clinical problem. We assessed methods to decrease accidental dural punctures (ADPs) and interventions to reduce PDPH following ADP. Multiple electronic databases were searched for randomised clinical trials (RCTs) of parturients having labour epidurals, in which the studied intervention could plausibly affect ADP or PDPH, and the incidence of at least one of these was recorded. Forty RCTs (n = 11,536 epidural insertions) were included, studying combined spinal-epidurals (CSEs), loss of resistance medium, prophylactic epidural blood patches, needle bevel orientation, ultrasound-guided insertion, epidural morphine, Special Sprotte needles, acoustic-guided insertion, administration of cosyntropin, and continuous spinal analgesia. The RCTs for CSE, loss of resistance medium, and prophylactic epidural blood patches were meta-analysed. Five methods reduced PDPH: prophylactic epidural blood patch {four trials, median quality score = 2, risk difference = -0.48 [95% confidence interval (CI): -0.88 to -0.086]}, lateral positioning of the epidural needle bevel upon insertion (one trial, quality score = 1), Special Sprotte needles [one trial, quality score = 5, risk difference = -0.44 (95% CI: -0.67 to -0.21)], epidural morphine [one trial, quality score = 4, risk difference = -0.36 (95% CI -0.59 to -0.13)], and cosyntropin [one trial, quality score = 5, risk difference = -0.36 (95% CI -0.55 to -0.16)]. Several methods potentially reduce PDPH. Special Sprotte needles, epidural morphine, and cosyntropin are thus far each supported by a single, albeit good quality trial. Prophylactic blood patches are supported by three trials, but these had flawed methodology. Mostly, trials were of limited quality, and further well-conducted, large studies are needed.

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Section: Resultsmentioning

confidence: 99%

Prevention of post‐dural puncture headache in parturients: a systematic review and meta‐analysis

Bradbury

Singh

Badder

et al. 2012

Acta Anaesthesiol Scand

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“…In the presence of a protocol for foetal resuscitation, however, the FHR abnormalities were not reflected as an increased rate of emergency CS ( . A more recent RCT found prolonged deceleration in 6.2% and 3.2% in CSE and EDA groups, respectively (Skupski et al 2009). The overall incidence of FHR changes was 7.9% with EDA.…”

Section: Foetal Heart Rate (Fhr) Tracingmentioning

confidence: 96%

“…Leighton & Halpern (2002) noted hypotension with an odds ratio of 74.2 in a meta-analysis of RCTs comparing EDA with systemic opioid analgesia (p < 0.001). EDA is associated with urinary retention in 2.7-40% of cases (Skupski et al 2009, Philipsen and Jensen 1989, Jain et al 2003, Olofsson et al 1997. Hyperthermia associated with EDA has been documented, but this is a finding based on a comparison of EDA with systemic opioid analgesia.…”

Section: Other Maternal Side Effectsmentioning

confidence: 99%

Intravenous patient-controlled analgesia with remifentanil in early labour

Volmanen¹

2011

Acta Anaesthesiologica Scandinavica

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Cover design Raimo Ahonen JUVENES PRINT TAMPERE 2010Volmanen, Petri, Intravenous patient controlled analgesia with remifentanil in early labour. AbstractIn four prospective clinical trials, 114 parturients used intravenous patient-controlled remifentanil analgesia during the 1 st stage of labour. The median effective dose per bolus was ascertained to be 0.4 μg/kg and the pain scores were reduced with this by a median of 2 on a numerical scale (0-10). Compared with nitrous oxide, 15 parturients included in a cross-over study reported a larger reduction in pain scores during remifentanil analgesia (1.5 vs. 0.5, p = 0.001) and better pain relief scores (2.5 vs. 0.5 on a ranked five point scale 0-4, p < 0.001). In a parallel study including 45 parturients, epidural analgesia (EDA, 20 ml bupivacaine 0.625 mg/ml and fentanyl 2 μg/ml) was associated with lower pain scores (5.2 vs. 7.3 with remifentanil, p = 0.004) but variables related to satisfaction with analgesia (pain relief score, proportion of mothers with desire to continue with the given medication and termination of the study due to inadequate pain relief) were similar. A comparison of two methods for timing the remifentanil bolus during the uterine contraction cycle suggested that delaying the bolus does not improve analgesia. A period effect was noted in the cross-over trial with higher pain scores and increased drug consumption during the second study period suggesting acute hyperalgesia.Side effects of remifentanil analgesia included respiratory depression warranting oxygen supplementation in 33% of parturients. Sedation was experienced by the parturients using remifentanil and this was scored as stronger than sedation during nitrous oxide and EDA. The number of parturients with nausea did not increase during remifentanil analgesia. Other maternal side effects included dizziness, a difficulty in visual focusing and itching. Foetal heart rate tracing abnormalities were noted. The incidence of abnormal tracings and decreased UapH were not different, however, from that observed during nitrous oxide or EDA. Apgar scores at 1 and 5 minute indicated no neonatal depression. Keywords

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“…Currently, the continuous lumbar epidural is the most widely used mode of pain control for labor and delivery, and is generally considered safe and effective. Combined spinal-epidural analgesia, being equally as safe 51 , is gaining popularity because of its ability to provide rapid analgesia with the potential benefit of shortening labor. However, current evidence lacks conviction to whether or not it shortens labor, rendering the findings suggestive at best.…”

Section: The Futurementioning

confidence: 99%

Neuraxial analgesia effects on labour progression: facts, fallacies, uncertainties and the future

Grant

Tao

Craig

et al. 2014

BJOG

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Approximately 60% of women who labor receive some form of neuraxial analgesia, but concerns have been raised regarding whether it negatively impacts the labor and delivery process. In this review, we attempt to clarify what has been established as truths, falsities, and uncertainties regarding the effects of this form of pain relief on labor progression, negative and/or positive. Additionally, although the term “epidural” has become synonymous with neuraxial analgesia, we discuss two other techniques, combined spinal-epidural and continuous spinal analgesia, that are gaining popularity, as well as their effects on labor progression.

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Adverse effects of combined spinal-epidural versus traditional epidural analgesia during labor

Abstract: There were no differences in the rate of PD or other adverse outcomes. Hypotension occurred more frequently with CSE during labor at term. The study supports both EPI and CSE during labor as safe and effective techniques for neuraxial analgesia.

Cited by 27 publications

References 18 publications

Prevention of post‐dural puncture headache in parturients: a systematic review and meta‐analysis

Prevention of post‐dural puncture headache in parturients: a systematic review and meta‐analysis

Intravenous patient-controlled analgesia with remifentanil in early labour

Neuraxial analgesia effects on labour progression: facts, fallacies, uncertainties and the future

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