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Published on: January 31, 2025
[Combined epidural-spinal analgesia during labor: a quantitative systematic review of the literature (meta-analysis)]
J Pascual-Ramírez1, J Haya Palazuelo, J M Valverde Mantecón
1Servicio de Anestesiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
Objective:
To perform a meta-analysis on the use of combined epidural-intrathecal analgesia during labor, including intrathecal fentanyl and/or morphine compared to usual epidural techniques.
Material And Method:
A literature search was made looking for randomized clinical trials in MEDLINE, EMBASE and Cochrane Library. The size of the effect for quantitative variables was analyzed by weighted mean difference; for qualitative variables, by odds ratio. Variables analyzed were: labor duration, type of delivery (spontaneous, instrumental and caesarean section), motor blockade, pain, and satisfaction. The analysis used in most cases was a random effects model.
Results:
A total of 21 trials, which included 3.646 patients, were selected out of the 38 initially found. The type of delivery variable with its 3 subgroups was the only one to show uniformity (p>Q 0.1; I(2)<50%). There were no differences in the variables analyzed except pain, which was advantageous for the group with intrathecal fentanyl or morphine by 0.55 points out of 10.
Conclusion:
Combined analgesia including intrathecal fentanyl-morphine does not offer significant advantages compared to the standard epidural.
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