Complications of labor analgesia: epidural versus combined spinal epidural techniques

Both epidural and combined spinal epidural (CSE) analgesia can provide maternal pain relief during labor. Currently, there are few data comparing the risks and complications of these two techniques. We recorded the incidence and severity of anesthetic-related complications in 1022 laboring parturients. Ninety-eight women opted for either no or parenteral analgesia, 388 chose epidural, and 536 requested CSE analgesia. Women choosing CSE analgesia most often received an intrathecal injection of sufentanil 10 micrograms at the time of epidural catheter insertion. The epidural catheters were then dosed as needed as the intrathecal analgesia waned. Women who received CSE analgesia were more likely to itch (41.4% vs 1.3%) or complain of nausea (2.4% vs 1.0%) or vomiting (3.2% vs 1.0%) than those receiving solely epidural analgesia. Patients who requested only epidural analgesia were more likely to suffer an unintended dural puncture (4.2% vs 1.7%). Fewer than 10% developed hypotension with either technique. The risk of headache was the same with both anesthetics (4%-10%) and did not differ from the incidence of headache in women not receiving neuraxial analgesia (10%-14%). Six patients required epidural blood patch for moderate to severe postural headache. Four of these women suffered a dural puncture with the 18-gauge Hustead epidural needle. The other two women had reportedly uncomplicated epidural and CSE analgesia. These data suggest either neuraxial analgesic technique can safely relieve the pain of labor. CSE analgesia is a safe alternative to epidural analgesia for labor and delivery.