section name header

Evidence summaries

Combined Spinal-Epidural Versus Epidural Analgesia in Labour

There appears to be little overall difference between combined spinal-epidural (CSE) and epidural analgesia in labour despite a slightly faster onset with CSE and less pruritus with epidurals. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 27studies with a total of 3 274 subjects. Combined spinal-epidural (CSE) compared with traditional epidural was more favourable in relation to need for rescue analgesia and urinary retention, and rate of instrumental delivery (RR 0.81; 95% CI 0.67 to 0.97; 6 trials, n=1015), but associated with more pruritus. For CSE versus low-dose epidurals, CSE had a faster onset of effective analgesia from time of injection but was associated with more pruritus. CSE was also associated with a clinically non-significant lower umbilical arterial pH. No differences between CSE and epidural were seen for maternal satisfaction, mobilisation in labour, modes of birth, incidence of post dural puncture headache or blood patch and maternal hypotension. It was not possible to draw any conclusions with respect to maternal respiratory depression, maternal sedation and need for labour augmentation.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).

    References

    • Simmons SW, Cyna AM, Dennis AT, Hughes D. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev 2007 Jul 18;(3):CD003401 [Review content assessed as up-to-date: 1 March 2012]. [PubMed]

Primary/Secondary Keywords