A Comparison of Epidural and Combined Spinal-Epidural Analgesia in Labour Analgesia

Aim: The aim of the study was to compare combined spinal-epidural (CSE) and epidural (EP) analgesia methods in labor analgesia. Material and Methods: The study was performed with 50 primigravid pregnant women who planned to have vaginal delivery. The patients were randomized into two equal groups: Group I: CSE analgesia group and Group II: EP analgesia group. A solution of 0.05% bupivacaine with 1.5 µg/ml fentanyl was prepared for using patient controlled epidural analgesia for both groups. Epidural catheters were introduced following the spinal administration of 1.25 mg bupivacain plus 12.5 µg fentanyl in patients in CSE analgesia group. Epidural solution infusion have been given to the EP analgesia group after the loading dose (10 ml 0.125% bupivacaine and 50 µg fentanil). Data were collected on maternal and fetal hemodynamic varibles, pain scores, motor blockade and total amount of consumed local anesthetic, the side effects. Results: Analgesia was effective in all patients. ‹nitiation time of analgesia in CSE group was much shorter than EP group (p<0.05). Better preserved maternal hemodynamics without hypotension, lower amounts of local anesthetics and beter patient satisfaction were observes in the CSE group compared with the EP group (p<0.05). Conclusion: Both CSE and EP analgesia methods used in this study were reliable and satisfactory for labor analgesia. Because of the faster initial analgesia, better maternal hemodynamics, shorter labor time in the first and second stage of labor and lower local anesthetic amounts, CSE analgesia method with lower doses of opioid and local anesthetic can be prefered to EP analgesia method.