Comparison of Combined Spinal Epidural Technique and Low Dose Epidural Technique in Progress of Labour

Abstract

The combined spinal epidural (CSE) technique is gaining popularity as it is associated with rapid onset of analgesia and it has a flexibility of an epidural catheter insertion. Though both epidural and CSE technique provide effective analgesia, epidural technique is reported to be associated with prolonged labour. By contrast, CSE technique is observed by many workers to be associated with shortened labour and increased rate of cervical dilatation. How-ever, it is not clear whether rapid rate of cervical dilatation is the physiologic effect of the CSE technique or it is an artifact of patient selection, as CSE technique is usually used in the patient in advanced stage of labour requiring rapid analgesia. We hypothesized that rapid cervical dilatation seen with CSE technique is physiologic effect of the technique and not mere an artifact and compared the CSE and epidural techniques with regard to progress of labour with special emphasis on rate of cervical dilatation and duration of labour. Sixty healthy nulliparous parturients in spontaneous labour with singleton fetus were randomized in a prospec-tive double blinded manner to receive either CSE analgesia or epidural analgesia. The epidural group (n= 30) received 10 ml bolus of 0.0625% bupivacaine+ 0.0002% fentanyl& the CSE group (n= 30) received intrathecally 25 mcg fentanyl + 1.25 mg bupivacaine. The rate of cervical dilatation was significantly greater in the CSE group as com-pared to the epidural group (3.5 ± 0.752 cm / hr vs. 2.0 ± 1.122, P = 0.000)& the duration of active stage of first stage of labour was significantly shorter in-group CSE (117.5 ±25.57 min vs. 192.5 ± 12 min, P = 0.000).

Keywords

• Combined spinal epidural technique
• Low dose epidural technique
• Rate of cervical dilatation
• Duration of labour