Aim: 1. To compare the analgesic efficacy of combined spinal epidural with epidural for labour analgesia using lower concentrations of Bupivacaine and Fentanyl. 2. To asses the effects of these agents on the maternal physiology, progress and duration of labour, mode of delivery, foetal and neonatal outcome.
Methods : A total of 40 labouring parturients of ASA 1 & 2 have been divided in to 2 groups (Epidural group & Combined Spinal Epidural group) with 20 in each group. Epidural group received 10 ml of 0.0625% Bupivacaine and 50 mcg of Fentanyl epiduraly as initial bolus, followed by intermittent epidural top ups of 7 ml of 0.0625% Bupivacaine and 2mcg/ml of Fentanyl every 1 hr. Combined Spinal Epidural group received 1.5 ml solution containing 0.625 mg of Bupivacaine and 25 mcg of Fentanyl intrathecally and followed 2 hrs later by intermittent top ups of 6 ml of 0.0625% Bupivacaine and 2mcg/ml of Fentanyl every 1 hr.
Results : With respect to the onset and quality of analgesia in Epidural and CSE groups, there were statistically significant differences. Analgesic efficacy was compared in terms of Time of first painless contraction, Time of loss of sensation to pin prick, visual analogue pain scales during first and second stage, Episiotomy pain relief and global assessment of quality of analgesia. CSE group showed statistically significant differences in terms of onset and quality of analgesia. No significant variations in duration and mode of delivery, maternal side effects and neonatal outcome.
Conclusion: CSE when compared to plain Epidural produced statistically significant pain relief and the side effects produced by combining Fentanyl and Bupivacaine on maternal power, passage and passenger were minimal, proving that the CSE is a safer and good alternative to epidural or labour analgesia.
Keywords: Bupivacaine; Combined Spinal Epidural; Epidural; Fentanyl; Parturients; Foetus.Corresponding Author
: M.R. Karthikeyan, Assistant Professor, Dept. of Anesthesiology, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, Tamil Nadu 600008, India.