Anaesthesia
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Meta Analysis
Meta-analysis of the success of block following combined spinal-epidural vs epidural analgesia during labour.
Observational studies suggest that combined spinal-epidural analgesia (CSE) is associated with more reliable positioning, lower epidural catheter replacement rates, and a lower incidence of unilateral block compared with epidural analgesia. However, evidence from high-quality trials still needs to be assessed systematically. We performed a systematic review that included 10 randomised controlled trials comparing CSE and epidural analgesia in 1722 labouring women in labour. ⋯ No differences were found for rates of epidural catheter replacement, epidural top-up, and epidural vein cannulation. On the basis of current best evidence, a consistent benefit of CSE over epidural analgesia cannot be demonstrated for the outcomes assessed in our review. A large randomised controlled trial with adequate power is required.