Review Note
Last Update: 03/02/2025 08:01 PM
Current Deck: ACG Part 2::Obstetrics
New Card (Unpublished)Currently Published Content
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Front
Commit #293156
SS_OB 1.24 Discuss the role of combined spinal epidural analgesia in labour
Back
Commit #293156Benefits of CSE over epidural :
- Faster onset of analgesia 2-5mins compared
- Reduced need for rescue analgesia
- Lower risk of unilateral block
- Decreased motor block - with superior leg power
- Despite purposeful dural puncture PDPH does not appear to be increased
- No difference in rates of forceps delivery or C section
Adverse effects :
- Increased incidence of puritis
- Increased incidence of fetal bradycardia compared to epidural
Spinal technique allows more rapid onset of symmetric analgesia including sacral analgesia than a conventional epidural technique.
- Involvement of a continuous technique provides analgesia throughout labour and delivery, with the option to convert to C section.
- Evidence suggests epidural catheters placed at time of CSE are at least as reliable or more reliable than stand alone epidurals.
TECHNIQUES
- Needle through needle
- Specially designed needles, risk of migration of needle during intrathecal administration. Placing epidural first increases risk of damage to the epidural catheter.
- Associated with greater patient satisfaction
- May be quicker to perform
- Separate needle technique
- Reduced rates of failure of spinal component : 5-20% failure reported for needle through needle, in experienced hands decreases to 1-5% failure compared to <5% failure
- Double barrelled needles
- Few studies on their efficacy.