Effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia

Abstract

Summary objectIve. Epidural (EA) and combined spinal-epidural (CSE) techniques have both been utilized for labor analgesia. This study compared the effects on the mother and newborn of these techniques in labor analgesia and anesthesia. Methods. Forty pregnant women received epidural analgesia with 15 mL of 0.125% ropivacaine (EA group) and 5 µg of sufentanil plus 2.5mg bupivacaine in the subarachnoid space (CSE group). Pain intensity, sensory blockade level, latency time, motor block intensity, labor analgesia duration, epidural analgesia duration, maternal hypotension, and pruritus were evaluated. The newborns were evaluated by Apgar and the neurological and adaptive capacity score (NACS) developed by Amiel-Tison. results. There were no significant statistical differences between groups for pain scores, latency time, sensory blockade level, and Apgar score. Motor block, labor analgesia duration, and epidural analgesia duration were greater in the CSE group, whose seven mothers had mild pruritus. The NACS were greater in the EA group after half, two, and 24 hours. Ninety five percent of EA group newborns and 60% of CSE group newborns were found to be neurologically healthy at the 24 hour examination. conclusIon. EA and CSE analgesia relieved maternal pain during obstetric analgesia, but CSE mothers had pruritus and a longer labor. Newborns of mothers who received epidural analgesia showed the best NACS.

Retrospective study of the association between epidural analgesia during labour and complications for the newborn

“…In the present study, we obtained mean Apgar index values 47 at one and five minutes in both groups, but these were lower in the group of neonates born under the effect of epidural analgesia. Nakamura et al (2009), Caliskan et al (2010 and Mousa et al (2012); found no differences in Apgar index between neonates whose mothers had received epidural analgesia and those whose mothers had not, with both groups having an index 47 at five minutes. However, account should be taken of the small sample sizes of these studies (n ¼ 40, 160, 150 and pregnant women, respectively) in comparison to the present investigation (n ¼2399).…”

Rebuilding the labor curve during neuraxial analgesia

“…Nakamura et al . recently reported an overall increase in terms of duration of labor under CSE analgesia, 14 even if underlying the benefits of CSE procedures.…”

Comparative study of fentanyl and morphine in addition to hyperbaric or isobaric bupivacaine in combined spinal anaesthesia for caesarean section

“…More than 60% of consultant obstetric anaesthetists in England used the CSEA technique during labour or caesarean section [13]. Combined spinal epidural anaesthesia allows for use of smaller doses of local spinal anaesthetics because the block can be supplemented at any time [14]. Compared to spinal block, the duration of the anaesthesia can be extended by using the CSEA technique.…”

“…Combined spinal epidural anaesthesia involves intentional subarachnoid blockade and epidural catheter placement during the same procedure. Advantages include rapid onset, profound neuraxial block, the ability to titrate or prolong blockade, lower total drug dosages, higher level of patient satisfaction and decreased incidence of accidental dural puncture [2, 3]. Sensorial blockade level is important for successful anaesthesia.…”