• Javier Pascual-Ramirez, Javier Haya, Faustino R Pérez-López, Silvia Gil-Trujillo, Rosa A Garrido-Esteban, and Ginés Bernal.
• Anesthesiology Department, Ciudad Real University General Hospital, Ciudad Real, Spain. pascrib@hotmail.com
• Int J Gynaecol Obstet. 2011 Sep 1;114(3):246-50.

ObjectiveTo determine whether combined spinal-epidural analgesia (CSEA) can decrease the known epidural effect of lengthening delivery.MethodsBetween April and May 2010, 144 women undergoing childbirth in hospital with epidural pain relief were randomized to receive either low-dose epidural analgesia (LEA) or CSEA. The spinal component included 2.5mg of bupivacaine, 25 μg of fentanyl, and 200 μg of morphine. The epidural component of the CSEA procedure was started once pain returned. The primary outcome was total labor duration measured from the time of initiation of labor analgesia to delivery.ResultsThe difference in duration between LEA (n=72) and CSEA (n=72) was 5 minutes for labor (P=0.82), 2 minutes for delivery (P=0.60), and 7 minutes for total labor duration (P=0.75). The combined group used less levobupivacaine (P<0.001) and had lower sensory blockade at the dermatomal level (P=0.037). Women in the CSEA group had a higher incidence of pruritus (P=0.002) and lightheadedness (P=0.02) during labor; and a higher incidence of pruritus (P=0.002), nausea-vomiting (P=0.026), and drowsiness (P=0.003) in the postpartum period.ConclusionAs compared with LEA, CSEA did not shorten the duration of labor length; however, it did reduce levobupivacaine consumption and motor weakness.Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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