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Perispinal analgesia for labour followed by patient-controlled infusion with bupivacaine and sufentanil: combined spinal–epidural vs. epidural analgesia alone

  • L. Vernis (a1), C. Dualé (a1), B. Storme (a1), J. P. Mission (a1), B. Rol (a1) and P. Schoeffler (a1)...



Background and objective: Combined spinal–epidural is an alternative technique to epidural analgesia for labour, but its benefits are not clearly identified.

Methods: A prospective, blinded, randomized study was undertaken involving 113 women attending a university hospital obstetric department. Analgesia was initiated with intrathecal bupivacaine 0.25% 1 mL + sufentanil 5 μg in the combined spinal–epidural group (n = 54), and with bupivacaine 0.125% + epinephrine 2.5 μg mL−1 + sufentanil 7.5 μg in the epidural group (n = 59). In both cases this was followed by patient-controlled epidural analgesia with bupivacaine 0.125% (+sufentanil 0.25 μg mL−1). Duration of labour, quality of analgesia and side-effects were compared between groups.

Results: In the combined spinal–epidural group, the onset of analgesia was faster (5 vs. 15 min, P < 0.001), the consumption of bupivacaine was lower (7.5 vs. 11.3 mg h−1, P = 0.003) and there was less unilateral analgesia (14.8% vs. 40.7%, P = 0.002) than in the epidural group. The characteristics of labour were similar in both groups. However, in the combined spinal–epidural group, there was a higher incidence of posterior presentation (25.9% vs. 10%, P = 0.03), pruritus (P < 0.001), hypotension (P = 0.002), somnolence (P = 0.01), nausea (P = 0.02) and one case of meningitis.

Conclusions: The combined spinal–epidural technique provided more effective analgesia during labour than epidural analgesia alone but offered no other advantage. It induced more adverse effects and this should be considered before routinely using the combined spinal–epidural technique.


Corresponding author

Correspondence to: Christian Dualé, Département d'Anesthésie-Réanimation, CHU de Clermont-Ferrand, Rue Montalembert, BP69, 63003, Clermont-Ferrand Cedex 1, France. E-mail:; Tel: +33 473751590; Fax: +33 473751591


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Chestnut DH, Owen CL, Bates JN, Ostman LG, Choi WW, Geiger MW. Continuous infusion epidural analgesia during labor: a randomized, double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine. Anesthesiology 1988; 68: 754759.
Beilin Y, Leibowitz AB, Bernstein HH, Abramovitz SE. Controversies of labor epidural analgesia. Anesth Analg 1999; 89: 969978.
Collis RE, Baxandall ML, Srikantharajah ID, Edge G, Kadim MY, Morgan BM. Combined spinal epidural analgesia with ability to walk throughout labour. Lancet 1993; 341: 767768.
Campbell DC, Camann WR, Datta S. The addition of bupivacaine to intrathecal sufentanil for labor analgesia. Anesth Analg 1995; 81: 305309.
Collis RE, Davies DW, Aveling W. Randomised comparison of combined spinal–epidural and standard epidural analgesia in labour. Lancet 1995; 345: 14131416.
Tsen LC, Thue B, Datta S, Segal S. Is combined spinal–epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia? Anesthesiology 1999; 91: 920925.
Nageotte MP, Larson D, Rumney PJ, Sidhu M, Hollenbach K. Epidural analgesia compared with combined spinal–epidural analgesia during labor in nulliparous women. New Engl J Med 1997; 337: 17151719.
Chestnut DH, Laszewski LJ, Pollack KL, Bates JN, Manago NK, Choi WW. Continuous epidural infusion of 0.0625% bupivacaine–0.0002% fentanyl during the second stage of labor. Anesthesiology 1990; 72: 613618.
Norris MC, Grieco WM, Borkowski M, et al. Complications of labor analgesia: epidural versus combined spinal epidural techniques. Anesth Analg 1994; 79: 529537.
Norris MC, Fogel ST, Holtmann B. Intrathecal sufentanil (5 vs. 10 microg) for labor analgesia: efficacy and side effects. Reg Anesth Pain Med 1998; 23: 252257.
Cohen SE, Cherry CM, Holbrook JrRH, el-Sayed YY, Gibson RN, Jaffe RA. Intrathecal sufentanil for labor analgesia – sensory changes, side effects, and fetal heart rate changes. Anesth Analg 1993; 77: 11551160.
Mardirosoff C, Dumont L, Boulvain M, Tramèr MR. Fetal bradycardia due to intrathecal opioids for labour analgesia: a systematic review. BJOG 2002; 109: 274281.
Cascio M, Heath G. Meningitis following a combined spinal–epidural technique in a labouring term parturient. Can J Anesth 1996; 43: 399402.
Harding SA, Collis RE, Morgan BM. Meningitis after combined spinal-extradural anaesthesia in obstetrics. Br J Anaesth 1994; 73: 545547.
Kartawiadi L, Vercauteren MP, Van Steenberge AL, Adriaensen HA. Spinal analgesia during labor with low-dose bupivacaine, sufentanil, and epinephrine. A comparison with epidural analgesia. Reg Anesth 1996; 21: 191196.
Price C, Lafreniere L, Brosnan C, Findley I. Regional analgesia in early active labour: combined spinal epidural vs. epidural. Anaesthesia 1998; 53: 951955.
Dresner M, Bamber J, Calow C, Freeman J, Charlton P. Comparison of low-dose epidural with combined spinal–epidural analgesia for labour. Br J Anaesth 1999; 83: 756760.
Hepner DL, Gaiser RR, Cheek TG, Gutsche BB. Comparison of combined spinal–epidural and low dose epidural for labour analgesia. Can J Anesth 2000; 47: 232236.
Gambling DR, Huber CJ, Berkowitz J, et al. Patient-controlled epidural analgesia in labour: varying bolus dose and lockout interval. Can J Anesth 1993; 40: 211217.
Ferrante FM, Rosinia FA, Gordon C, Datta S. The role of continuous background infusions in patient-controlled epidural analgesia for labor and delivery. Anesth Analg 1994; 79: 8084.
Curry PD, Pacsoo C, Heap DG. Patient-controlled epidural analgesia in obstetric anaesthetic practice. Pain 1994; 57: 125127.
Gambling DR, Sharma SK, Ramin SM, et al. A randomized study of combined spinal–epidural analgesia versus intravenous meperidine during labor: impact on cesarean delivery rate. Anesthesiology 1998; 89: 13361344.
Roux M, Wattrisse G, Subtil D, et al. A comparison of early combined spinal epidural analgesia versus epidural analgesia on labor stage duration and obstetric outcome. Anesthesiology 1996; 85: A851.
Herman NL, Calicott R, Van Decar TK, Conlin G, Tilton J. Determination of the dose-response relationship for intrathecal sufentanil in laboring patients. Anesth Analg 1997; 84: 12561261.
Abouleish A, Abouleish E, Camann W. Combined spinal–epidural analgesia in advanced labour. Can J Anesth 1994; 41: 575578.
Viscomi CM, Rathmell JP, Mason SB, Livermore M, Schapiro H. Analgesic efficacy and side effects of subarachnoid sufentanil–bupivacaine administered to women in advanced labor. Reg Anesth 1996; 21: 424429.


Perispinal analgesia for labour followed by patient-controlled infusion with bupivacaine and sufentanil: combined spinal–epidural vs. epidural analgesia alone

  • L. Vernis (a1), C. Dualé (a1), B. Storme (a1), J. P. Mission (a1), B. Rol (a1) and P. Schoeffler (a1)...


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