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Chapter 7 - Combined Spinal-Epidural Anesthesia/Analgesia

Published online by Cambridge University Press:  08 March 2019

Tauqeer Husain
Ashford and St Peter’s NHS Foundation Trust, Surrey
Roshan Fernando
Womens Wellness and Research Centre, Hamad Medical Corporation, Qatar
Scott Segal
Wake Forest University, North Carolina
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Obstetric Anesthesiology
An Illustrated Case-Based Approach
, pp. 30 - 34
Publisher: Cambridge University Press
Print publication year: 2019

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Rawal, N, Holmstrom, B, Crowhurst, JA, Van Zundert, A. The combined spinal epidural technique. Anesth Clin North Am 2000; 18:267–95.CrossRefGoogle ScholarPubMed
Camann, WR, Mintzer, BH, Denney, RA, Datta, S. Intrathecal sufentanil for labor analgesia. Anesthesiology 1993; 78:870–74.CrossRefGoogle ScholarPubMed
Collis, RE, Baxandall, ML, Srikantharajah, ID, et al. Combined spinal epidural analgesia: technique, management and outcome of 300 mothers. Int J Obstet Anesth 1994; 3:7581.CrossRefGoogle ScholarPubMed
Preston, R. The role of combined spinal epidural analgesia for labour: is there still a question? Can J Anaesth 2007; 54:914.CrossRefGoogle Scholar
Simmons, SW, Taghizadeh, N, Dennis, AT, Hughes, D, Cyna, AM. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev 2012; 10:CD003401.Google ScholarPubMed
Van de Velde, M, Teunkens, A, Hanssens, M, Vandermeersch, E, Verhaeghe, J. Intrathecal sufentanil and fetal heart rate abnormalities: a double blind, double placebo controlled trial comparing two forms of combined spinal epidural analgesia with epidural analgesia in labor. Anesth Analg 2004; 98:1153–59.Google ScholarPubMed
Van de Velde, M, Mignolet, K, Vandermeersch, E, Van Assche, A. Prospective, randomized comparison of epidural and combined spinal epidural analgesia during labor. Acta Anaesthesiol Belg 1999; 50:129–36.Google ScholarPubMed
Collis, RE, Davies, DWL, Aveling, W. Randomised comparison of combined spinal epidural and standard epidural analgesia in labour. Lancet 1995; 345:1413–16.CrossRefGoogle ScholarPubMed
Wilson, MJ, Cooper, G, MacArthur, C, Shennan, A. Randomized controlled trial comparing traditional with two mobile epidural techniques: anesthetic and analgesic efficiency. Anesthesiology 2002; 97:1567–75.Google Scholar
Van de Velde, M. Combined spinal epidural analgesia for labor and delivery: a balanced view based on experience and literature. Acta Anaesthesiol Belg 2009; 60(2):109–22.Google ScholarPubMed
Gambling, D, Berkowitz, J, Farrell, TR, Pue, A, Shay, D. A randomized controlled comparison of epidural analgesia and combined spinal-epidural analgesia in a private practice setting: pain scores during first and second stages of labor and at delivery. Anesth Analg 2013; 116:636–43.CrossRefGoogle Scholar
Capiello, E, O’Rourke, N, Segal, S, Tsen, LC. A randomized trial of dural puncture epidural technique compared with the standard epidural technique for labor analgesia. Anesth Analg 2008; 107:1646–51.CrossRefGoogle Scholar
Heesen, M, Van de Velde, M, Klohr, S, et al. Meta-analysis of the success of block following combined spinal-epidural vs epidural analgesia during labour. Anaesthesia 2014; 69:6471.CrossRefGoogle ScholarPubMed
Thomas, JA, Pan, PH, Harris, LC, Owen, MD, D’Angelo, R. Dural puncture with a 27-gauge Whitacre needle as part of a combined spinal-epidural technique does not improve labor epidural catheter function. Anesthesiology 2005; 103:1046–51.CrossRefGoogle Scholar
Reynolds, F. Damage to the conus medullaris following spinal anaesthesia. Anaesthesia 2001; 56:238–47.CrossRefGoogle ScholarPubMed
Van Gessel, EF, Forster, A, Gamulin, Z. Continuous spinal anesthesia: where do spinal catheters go? Anesth Analg 1993; 76:1004–7.CrossRefGoogle ScholarPubMed
Van de Velde, M, Teunkens, A, Hanssens, M, van Assche, FA, Vandermeersch, E. Post dural puncture headache following combined spinal epidural or epidural anaesthesia in obstetric patients. Anaesth Intensive Care 2001; 29:505–99.Google ScholarPubMed
Mardirosoff, C, Dumont, L, Boulvain, M, Tramer, MR. Fetal bradycardia due to intrathecal opioids for labour analgesia: a systematic review. BJOG 2002; 109:274–81.CrossRefGoogle ScholarPubMed
Cheng, SL, Bautista, D, Leo, S, Sia, TH. Factors affecting fetal bradycardia following combined spinal epidural for labor analgesia: a matched case-control study. J Anesth 2013; 27:169–74.CrossRefGoogle ScholarPubMed
Reynolds, F, Seed, PT. Anaesthesia for caesarean section and neonatal acid-base status: a meta-analysis. Anaesthesia 2005; 60:636–53.CrossRefGoogle ScholarPubMed
Langesaeter, E, Dyer, RA. Maternal haemodynamic changes during spinal anaesthesia for caesarean section. Curr Opin Anaesthesiol 2011; 24:242–48.CrossRefGoogle ScholarPubMed
Roofthooft, E, Van de Velde, M. Low-dose spinal anaesthesia for caesarean section to prevent spinal-induced hypotension. Curr Opin Anaesthesiol 2008; 21:259–62.CrossRefGoogle ScholarPubMed
Arzola, C, Wieczorek, PM. Efficacy of low-dose bupivacaine in spinal anaesthesia for caesarean delivery: systematic review and meta-analysis. Br J Anaesth 2011; 107:308–18.CrossRefGoogle ScholarPubMed
Vercauteren, MP, Coppejans, HC, Hoffman, VH, Mertens, E, Adriaensen, HA. Prevention of hypotension by a single 5-mg dose of ephedrine during small dose spinal anesthesia in prehydrated cesarean delivery patients. Anesth Analg 2000; 90:324–27.Google ScholarPubMed
Coppejans, HC, Hendrickx, E, Goossens, J, Vercauteren, MP. The sitting versus right lateral position during combined spinal-epidural anesthesia for cesarean delivery: block characteristics and severity of hypotension. Anesth Analg 2006; 102:243–47.CrossRefGoogle ScholarPubMed
Coppejans, HC, Vercauteren, MP. Low-dose combined spinal-epidural anesthesia for cesarean delivery: a comparison of three plain local anesthetics. Acta Anaesth Belg 2006; 57:3943.Google ScholarPubMed
Van de Velde, M, Van Schoubroeck, D, Jani, J, et al. Combined spinal epidural anestehsia for cesarean section: dose dependent effects of hyperbaric bupivacaine on maternal hemodynamics. Anesth Analg 2006; 103:187–90.CrossRefGoogle Scholar
McNaught, AF, Stocks, GM. Epidural volume extension and low-dose sequential combined spinal-epidural blockade: two ways to reduce spinal dose requirement for caesarean section (review). IJOA 2007; 16:346–53.Google ScholarPubMed
Kinsella, SM. A prospective audit of regional anaesthesia failure in 5,080 caesarean sections. Anaesthesia 2008; 63:822–32.CrossRefGoogle Scholar

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