Combined spinal-epidural analgesia in advanced labour

Area of Science:

• Anesthesiology
• Obstetrics
• Pain Management

Background:

• Epidural analgesia is standard for labor pain but can be difficult to establish in advanced labor.
• The combined spinal-epidural (CSE) technique offers rapid spinal analgesia onset with epidural catheter flexibility.

Purpose of the Study:

• To evaluate the effectiveness of intrathecal opioids combined with low-dose local anesthetics for pain relief in parturients during advanced, active labor.

Main Methods:

• An open-label, non-randomized trial involving 38 term parturients in advanced labor.
• Spinal injection of bupivacaine (2.5 mg) and sufentanil (10 mcg) followed by epidural catheter placement.
• Assessment of analgesia onset, motor blockade (Bromage criteria), and side effects (pruritus, nausea).

Main Results:

• Rapid onset of analgesia (< 5 minutes) in all patients.
• Mean cervical dilatation at intervention was 6.1 cm.
• 60% (23/38) achieved vaginal delivery without supplemental anesthesia; 15 patients required epidural top-ups.

Conclusions:

• The CSE technique with intrathecal opioids and low-dose local anesthetics is effective for pain relief in advanced labor.
• This technique provides rapid analgesia and allows for supplemental pain management if needed.
• It is a viable option for parturients in advanced labor where traditional epidural analgesia may be challenging.