Neuraxial Block for Labour Analgesia - Is the Combined Spinal Epidural (CSE) Modality a Good Alternative to Conventional Epidural Analgesia?

AT Sia, WR Camann, CE Ocampo, RW Goy, HM Tan, S Rajammal
Correspondence: Dr A T Sia, athsia@kkh.com.sg

ABSTRACT
Aim Apart from conventional epidural analgesia (EA), the combined spinal-epidural (CSE) modality is fast becoming a popular technique for treating labour pain. In this study, we investigated the differences in the patient profile and outcome between CSE and EA for labour pain in KK Women's and Children's Hospital.
Methodology Data pertaining to 1,532 healthy parturients who had received either CSE or EA for labour pain during a six-month period was systematically collected by using a specially designed form. Multiple logistic regression analysis was used to determine the independent predictors of patient satisfaction and the relation of parturient factors on the choice of block. The side effects and the outcome of labour were also compared.
Results CSE accounted for 80% of all neuraxial blocks performed for labour analgesia (vs 20% for EA). Anaesthesiologists were more inclined to using CSE than EA for multiparous parturients (OR 2.03, p<0.01) in a more painful (OR=1.61, p=0.03) and advanced stage of labour (OR=1.12, p=0.03). The need for supplemental analgesics was greater for EA (p<0.01). Patient satisfaction was higher for CSE (OR=1.77, p<0.026). CSE had a higher risk of pruritus (29% vs 14%, p<0.01) but lower risk of post block neural deficits (0% vs 2%, p<0.01) than EA. No difference in the mode of delivery was detected between the two groups.
Conclusion CSE is a safe and good alternative to EA as a technique of neuraxial block for labour analgesia.

Keywords: combined spinal epidural, epidural, analgesia, labour
Singapore Med J 2003; 44(9): 464-470