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Combined Spinal-Epidural Faster Than Continuous Epidural in PCA


 

HOLLYWOOD, FLA. — The addition of spinal analgesia to a routine walking epidural patient-controlled analgesia regimen shortened the time to pain relief in a randomized study.

In the study of 136 patients who were randomized to receive a combined spinal-epidural (CSE) regimen or a routine epidural regimen, the CSE group achieved full analgesia satisfaction in a mean of 8 minutes, compared with 16 minutes in the epidural group.

Moreover, the addition of spinal analgesia did not affect the quality of the block, side effects, or patient satisfaction with analgesia, Dr. Shaul Cohen reported in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Patients in the CSE group received initiation by 2mg of intrathecal ropivacaine and 5 mcg sufentanil via a PENCAN 25G spinal needle followed by epidural patient-controlled analgesia (PCA). The epidural group received 20 mL of 0.04% ropivacaine plus 1 mcg/mL sufentanil plus 2 mcg/mL epinephrine epidural study solution followed by epidural PCA analgesia.

All patients received an infusion of the study solution at 4 mL/hr, and a PCA dose of 4 mL with a lockout time of 10 minutes, noted Dr. Cohen of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, N.J.

After the initial neuraxial dose administration, patients were asked to rate their pain satisfaction at each contraction. In those with a visual analog score of greater than three at 20 minutes, a 5- to 10-mL bolus of study solution was given every 10 minutes (up to 20 mL) as needed to achieve a score of three or less.

A rescue dose of 5 mL of 0.25% ropivacaine was provided every 10 minutes (up to 20 mL and until patients could no longer ambulate) to those whose score remained above three after the maximum amount of study solution had been provided; the infusion rate was increased by 2 mL/hr at each interval where an intervention was required (to a maximum of 16 mL/hr).

The CSE and epidural groups were similar with regard to weight, height, and parity. Initial pain scores were significantly higher in the CSE group (7.8 vs. 6.9), and mean PCA volume was higher in that group (22 mL vs. 13 mL), but the groups did not differ in regard to first- and second-stage duration, initial cervical dilation, total infusion time, pain scores at time of relief, intravenous Pitocin use, pruritus, sedation, nausea, vomiting, urinary retention, analgesia satisfaction overall and during the first and second stages of labor, number of patients able to ambulate, or APGAR scores, Dr. Balki noted.

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