Single Space Combined Spinal-Extradural Technique for Analgesia in Labour

Abstract

We have used the single space combined spinal-extradural technique for mothers requesting analgesia in labour. Intrathecal plain bupivacaine 5 mg produced a median time to analgesia of 3 min. There was inadequate abdominal analgesia after 10 min in 16% of recipients, although all had good perineal analgesia. The median height of block was T8 (range T4-L2) and mean duration of analgesia 72 (SD 21) min. Hypotension occurred in two of 30 mothers, but responded to fluids and ephedrine. There were no post-spinal headaches. This technique is suitable for those parturients requesting analgesia in active labour who may not have time to achieve extradural analgesia before delivery. The extradural catheter is used to improve analgesia if the subarachnoid block is inadequate, or if labour continues beyond the duration of the subarachnoid block.

Recent advances in obstetric anesthesia

“…With the employment of this opioid/local anesthetic combination, the patient may ambulate with assistance. A study by Stacey et al [16], using 5 mg intrathecal bupivacaine, produced an unacceptably high incidence of motor blockade. The addition of epinephrine to the local anesthetic has been shown to significantly prolong the duration of effective analgesia [17].…”

“…In addition, the risk of CSF leakage through the intentional dural puncture made by the spinal needle is decreased. The increase in epidural pressure, resulting from the administration of epidural drugs, can be expected to splint the dura against the arachnoid membrane [16]. With a single-segment CSE technique, the spinal needle is deflected somewhat as it exits the epidural needle, and approaches the dura at an angle.…”

“…With a single-segment CSE technique, the spinal needle is deflected somewhat as it exits the epidural needle, and approaches the dura at an angle. The holes in the dura and subarachnoid are less likely to overlap, thereby reducing the risk of CSF leakage [16]. Finally, there are conflicting reports as to the prophylactic effect of epidural or spinal opioids against PDPH [24][25][26].…”

The effect of intrathecal epinephrine on epidural infused analgesics during labor

“…However, 40% of patients had complete or nearly complete motor block when bupivacaine 5 mg was used even without epinephrine. 13 Thus, the degree of motor block varies with the dose of intrathecal bupivacaine, as well as the use of epinephrine. In our study, 22% of patients who received epinephrine and 6% of patients who did not had motor block.…”

Combined Spinal and Epidural Anaesthesia for Abdominal Surgery: A New Technique

“…The technique has been shown to be superior in orthopaedic surgery of pelvis and lower limbs, Caesarean section and analgesia in labour [2,4,5]. We have used the technique with good effect in all types of surgery and more so in abdominal surgery.…”