Comparison of epidural technique with combined spinal epidural technique for labor analgesia

Introduction: For pain relief during labor, regional analgesia is considered the most preferred technique; nevertheless the best method is yet to be determined. We carried out a randomized study to assess efficacy, safety & maternal satisfaction with standard epidural and combined spinal epidural (CSE) analgesia technique among 40 primigarvida. Materials and Methods: Healthy primigarvida in labor having cervical dilatation between 3 to 5 cm were assigned randomly to receive either epidural or CSE for labor analgesia. Analgesia was established in Epidural group with 12ml of 0.0625% bupivacaine added with 2µg/ml fentanyl & in CSE group with intrathecal injection of 2.5mg 0.5% heavy bupivacaine plus fentanyl 25µg (total 2 ml). In both groups whenever patient's VAS>3, 2nd dose was given in form of epidural bolus 10ml 0.0625% bupivacaine + 2µg/ml fentanyl, followed by infusion of same concentration at 8 ml/h. Results: The onset of labor analgesia was significantly faster in CSE group (5.5±1.9 vs. 13±5.9 minutes, p<0.001) compared to epidural group. More than 75% patients in both groups didn't developed any motor blockade. The total dose of bupivacaine used in Epidural group was 20.5±6.6mg whereas it was only 8.5±7.7mg in CSE group which was significant low than epidural group; same was for fentanyl (65.1±21.6µg in epidural and 44.4±24.6µg in CSE group). In CSE group 35% patients had pruritus and 10% had nausea and vomiting, but none had in epidural group. Mothers have labeled quality of analgesia comparable. Conclusions: Both techniques were equally effective in relieving the pain during labor, but the onset of analgesia with CSE technique was faster than epidural group. The LSCS rate was comparable and complications were minor. Thus CSE can be safe and effective alternative to standard epidural technique for labor analgesia.