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

Vernis, L.; Dualé, Christian; Storme, B.; Mission, Jean-Paul; Rol, B.; Schoeffler, P.

doi:10.1097/00003643-200403000-00004

Cited by 9 publications

(9 citation statements)

References 20 publications

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“…It also allows the anaesthetist to supplement and titrate analgesia using the indwelling epidural catheter [12–14]. Several prospective trials [15–20] and a recent meta‐analysis [21] reviewing over 2500 women in 19 randomised controlled trials have consistently demonstrated a faster onset of analgesia (of approximately 10 min [13]) with a CSE than with a standard low‐dose epidural technique, while both approaches provide high quality analgesia and excellent maternal satisfaction. Owing to the subarachnoid injection of opioids, CSE analgesia has been associated with a greater incidence of pruritus than epidural analgesia [20–22].…”

Section: Initiating Neuraxial Analgesiamentioning

confidence: 99%

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Loubert¹,

Hinova

Fernando

2011

Anaesthesia

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SummarySeveral strategies and alternative therapies have been used to provide analgesia for labour pain. Over the last few years, a number of improvements have enhanced the efficacy and safety of neuraxial analgesia and ultimately have improved mothers' satisfaction with their birth experience. As labour analgesia is a field of obstetric anaesthesia that is rapidly evolving, this review is an update, from a clinical point of view, of developments over the last 5-7 years. We discuss advantages and controversies related to combined spinal-epidural analgesia, patient controlled epidural analgesia and the integration of computer systems into analgesic modalities. We also review the recent literature on future clinical and research perspectives including ultrasound guided neuraxial block placement, epidural adjuvants and pharmacogenetics. We finally look at the latest work with regards to epidural analgesia and breastfeeding. Several strategies and alternative therapies have been used to provide analgesia for one of women's most painful experiences in life, labour pain. These include non-pharmacological approaches such as hypnosis, acupuncture, hydrotherapy and transcutaneous electrical nerve stimulation as well as the administration of nitrous oxide and low-dose sevoflurane and parenteral opioids. Although some of these therapies provide satisfactory pain relief from the mothers' point of view [1,2], there is evidence that neuraxial local anaesthetics and opioids yield superior and more reliable analgesia than these aforementioned methods [3,4].Although invasive, neuraxial labour analgesia is considered safe practice. Over the last decade, several improvements have enhanced the efficacy and safety of neuraxial analgesia and ultimately have improved mothers' satisfaction with their birth experience. These developments include the introduction of combined spinal-epidural (CSE) analgesia, 'mobile epidurals', patient controlled epidural analgesia (PCEA), computer assisted injection of epidural solutions and ultrasound guided neuraxial techniques. Some of these advances have already been introduced into clinical practice while ongoing research is stimulated by the exciting clinical perspectives brought forward by other developments. This review focuses on the recent advances in neuraxial labour analgesia and on the relevant scientific literature published in the last 5 years. We performed a MEDLINE-based search of all the literature published from January 2005, using the following keywords: labour analgesia; epidural; spinal; combined spinal-epidural; pregnancy; obstetric; neostigmine; clonidine; pharmacogenetics; and breastfeeding. We focussed our research on prospective, randomised controlled trials as well as meta-analysis and further completed our review by including retrospective observational trials and case reports where relevant. For clarity of discussion and when considered necessary, we also included literature from earlier years. Initiating neuraxial analgesiaUltrasound guided neuraxial techniques Ultrasound i...

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Section: Initiating Neuraxial Analgesiamentioning

confidence: 99%

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Loubert¹,

Hinova

Fernando

2011

Anaesthesia

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“…Nevertheless, judging by the numbers of published cases, it could be the second commonest neurological complication of neuraxial analgesia in labour, after paraesthesiae. Loo et al 6 found 20 cases, 31,[43][44][45][46][47][48][49][50][51][52][53][54] while at least seven others [55][56][57][58][59][60][61] and one case of Herpes simplex encephalitis 62 among parturients, and dozens more among non-obstetric patients, have been reported since.…”

Section: Sources Of Infectionmentioning

confidence: 99%

Infection as a complication of neuraxial blockade

Reynolds

2005

International Journal of Obstetric Anesthesia

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“…). Ten randomised studies were eligible for inclusion, providing data on 1722 parturients. Table gives details of the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…The RR for epidural catheter replacement after CSE vs epidural was 0.57 (95% CI 0.32–1.03). Data on unilateral block were reported for 657 parturients in five studies . The risk for unilateral block was significantly reduced in the CSE group, 0.48 (95% CI 0.24–0.97, p = 0.04); however, there was significant heterogeneity between the studies (I 2 = 69%, p = 0.01).…”

Section: Resultsmentioning

confidence: 99%

Meta‐analysis of the success of block following combined spinal‐epidural vs epidural analgesia during labour

Heesen

Velde²,

Klöhr

et al. 2013

Anaesthesia

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SummaryObservational studies suggest that combined spinal-epidural analgesia (CSE) is associated with more reliable positioning, lower epidural catheter replacement rates, and a lower incidence of unilateral block compared with epidural analgesia. However, evidence from high-quality trials still needs to be assessed systematically. We performed a systematic review that included 10 randomised controlled trials comparing CSE and epidural analgesia in 1722 labouring women in labour. The relative risk of unilateral block was significantly reduced after CSE vs epidural analgesia (0.48, 95% CI 0.24-0.97), but significant between-study heterogeneity was present (I 2 = 69%, p = 0.01). No differences were found for rates of epidural catheter replacement, epidural top-up, and epidural vein cannulation. On the basis of current best evidence, a consistent benefit of CSE over epidural analgesia cannot be demonstrated for the outcomes assessed in our review. A large randomised controlled trial with adequate power is required. Combined spinal-epidural analgesia (CSE) has emerged as an alternative to epidural analgesia for pain relief during labour [1]. During a needle-through-needle CSE, the epidural space is first identified with an epidural needle, followed by insertion of a long spinal needle and injection of the spinal dose. The spinal needle is then removed and an epidural catheter is inserted through the epidural needle. A Cochrane review comparing the CSE technique with traditional (bupivacaine ≥ 0.25%) and low-dose epidural analgesia in labour [2] found that CSE was associated with a higher incidence of pruritus, but a lower incidence of urinary retention and need for rescue analgesia compared with traditional epidural, as well as a faster onset of analgesia when compared with low-dose epidural.No differences in labour outcome were found. Several observational studies reported that CSE was associated with a lower rate of unilateral block [3,4] and epidural catheter replacement [3][4][5]. These findings could be due to the spinal component's having a clear endpoint of flow of cerebrospinal fluid through the needle, indicating correct positioning of the epidural needle. Unilateral block and the need for re-siting the catheter during labour imply that the parturient continues to suffer from pain, and are stressful for both parturient and anaesthetist. If caesarean section becomes neces-64

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

Cited by 9 publications

References 20 publications

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years

Infection as a complication of neuraxial blockade

Meta‐analysis of the success of block following combined spinal‐epidural vs epidural analgesia during labour

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