• Curr Opin Anaesthesiol · Jun 2020

    Review

    Combined spinal epidural for labour analgesia and caesarean section: indications and recommendations.

    The combined spinal-epidural offers faster-onset and superior labour analgesia.

    pearl
    • Emilia Guasch, Nicolas Brogly, and Fernando Gilsanz.
    • Department of Anaesthesia and Reanimation, Maternal Hospital, Hospital Universitario La Paz.
    • Curr Opin Anaesthesiol. 2020 Jun 1; 33 (3): 284-290.

    Purpose Of ReviewEven if its use is scarce in most countries, many articles concerning combined spinal epidural (CSE) were published. In this review, we present the latest advances concerning CSE in obstetrics.Recent FindingsDuring labour, CSE improves epidural analgesia quality. Epidural with intradural opioids can produce maternal hypotension and foetal heart rate abnormalities (FHR-Ab), without increasing the caesarean section rate. For caesarean section, CSE decreases the neuraxial block failure rate, with no significant increase of complications. Epidural volume extension (EVE) after CSE for caesarean section could be an interesting option even though more evidence is needed.SummaryFor labour analgesia, CSE has the fastest onset time of analgesia. Its side effects have no consequences on maternal, labour or foetal outcomes. It provides better analgesia than epidural analgesia and can be used for external cephalic version and high-risk patients. For caesarean section, CSE has become the reference neuraxial technique for low-dose spinal anaesthesia, with higher success rate compared with regular spinal anaesthesia. Recent systematic revisions did not confirm this superiority. CSE offers the advantage of EVE, intraoperative top-ups, postoperative administration of neuraxial opioids and local anaesthetics. The risk of complications is balanced by the benefits of the technique.

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    The combined spinal-epidural offers faster-onset and superior labour analgesia.

    Daniel Jolley  Daniel Jolley
     
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