+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Combined spinal-epidural analgesia for labor pain: best timing of epidural infusion following spinal dose

Combined spinal-epidural analgesia for labor pain: best timing of epidural infusion following spinal dose

Archives of Gynecology and Obstetrics 279(3): 329-334

The combined spinal-epidural analgesia (CSEA) technique for labor pain has attained wide spread popularity in obstetric anesthesia. The onset of analgesia is rapid and reliable, and maternal satisfaction is very high. However, the best timing of an epidural infusion following the spinal dose and its effect on the total local anesthetics consumption has not been well determined. A total of 144 consenting healthy nulliparous parturients whose labor was induced and who labored under regional analgesia were enrolled in this study. Following induction of the CSEA with intrathecal injection of bupivacaine, 2.5 mg and fentanyl, 25 microg, the patients were randomized into one of four groups to receive a subsequent continuous epidural infusion [E (3), E (30), E (60) and E (90)], depending on the timing of the initiation of epidural infusion of 0.1% ropivacaine, 0.0002% fentanyl and 1:500,000 epinephrine at the rate of 10 ml/h. In study Groups E (3), E (30), E (60) and E (90), epidural infusion was initiated 3, 30, 60 and 90 min, respectively following spinal induction dose. Patients requesting additional labor analgesia were given an epidural bolus (8 ml) of ropivacaine, 0.2%. The number of parturients requesting additional boluses of ropivacaine and the total dose of ropivacaine required for labor analgesia were registered. The numbers of patients who required additional boluses of ropivacaine in Group E (3) and Group E (30) were significantly less than those in Group E (60) and Group E (90). The total dose of ropivacaine required for labor pain in Group E (3) and Group E (30) was insignificantly smaller than the total dose required in Group E (60) and Group E (90). Our results suggest that the best timing of epidural infusion following spinal dose was within 30 min of spinal induction dose.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 052181056

Download citation: RISBibTeXText

PMID: 18629529

DOI: 10.1007/s00404-008-0725-1

Related references

Effects of electroacupuncture on reducing labor pain and complications in the labor analgesia process of combined spinal-epidural analgesia with patient-controlled epidural analgesia. Archives of Gynecology and Obstetrics 2018, 2018

From balanced analgesia to epidural analgesia or combined spinal-epidural analgesia for relief of labor pain. Masui. Japanese Journal of Anesthesiology 59(3): 319-327, 2010

A randomized controlled comparison of epidural analgesia and combined spinal-epidural analgesia in a private practice setting: pain scores during first and second stages of labor and at delivery. Anesthesia and Analgesia 116(3): 636-643, 2013

Effect of Epidural Test Dose on Ambulation after a Combined Spinal Epidural Technique for Labor Analgesia. Anesthesiology Abstracts of Scientific Papers Annual Meeting ( ): Abstract No A-1053, 2002

The effect of epidural test dose on motor function after a combined spinal-epidural technique for labor analgesia. Anesthesia and Analgesia 96(4): 1167-72, Table of Contents, 2003

A randomized trial of breakthrough pain during combined spinal-epidural versus epidural labor analgesia in parous women. Anesthesia and Analgesia 108(1): 246-251, 2009

Combined spinal-epidural analgesia and epidural analgesia in labor: effect of intrathecal fentanyl vs. epidural bupivacaine as a bolus. Journal of the Medical Association of Thailand 90(7): 1368-1374, 2007

Postoperative Analgesia with Continuous Epidural Ropivacaine Infusion and Patient Controlled Epidural Analgesia after Combined Spinal-Epidural Anesthesia. Anesthesiology Abstracts of Scientific Papers Annual Meeting ( ): Abstract No A-1043, 2003

Patient-controlled epidural analgesia following combined spinal-epidural analgesia in labour: the effects of adding a continuous epidural infusion. Anaesthesia and Intensive Care 33(4): 452-456, 2005

Comparison of midwife top-ups, continuous infusion and patient-controlled epidural analgesia for maintaining mobility after a low-dose combined spinal-epidural. British Journal of Anaesthesia 82(2): 233-236, 1999

Success of Spinal and Epidural Labor Analgesia: Comparison of Loss of Resistance Technique Using Air versus Saline in Combined Spinal-Epidural Labor Analgesia Technique. Yearbook of Anesthesiology and Pain Management 2010: 284-285, 2010

Success of spinal and epidural labor analgesia: comparison of loss of resistance technique using air versus saline in combined spinal-epidural labor analgesia technique. Anesthesiology 111(1): 165-172, 2009

Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques. Obstetric Anesthesia Digest 37(3): 158-160, 2017

Combined spinal-epidural for labor analgesia with low-dose bupi- vacaine but without any opioid in the spinal component: can we improve upon the traditional?. Acta Anaesthesiologica Belgica 66(4): 9-15, 2016

Low-dose spinal anesthesia using combined spinal and epidural technique for cesarean delivery An intrathecal opioid, not epidural injection of saline, improves intraoperative analgesia. Regional Anesthesia & Pain Medicine 26(6): 588-589, November-December, 2001