Is combined spinal-epidural more effective compared to epidural for labor analgesia?

Aims and Objectives: This study aims to compare the effectiveness of combined spinal-epidural (CSE) analgesia and low-dose epidural analgesia in labor and study their effects on maternal and fetal well-being. Material and Methods: Sixty parturients classified as the American Society of Anesthesiologists I, in established labor and requesting epidural, were alternately divided into two groups (30 each). Group I received 0.125% bupivacaine with fentanyl 2 ug/ml epidural analgesia. Group II received CSE analgesia comprising of 25 μg fentanyl in the intrathecal space and 0.125% bupivacaine with fentanyl 2 ug/ml for epidural analgesia. Onset of analgesia, maternal hemodynamics, fetal heart rate, duration of labor, ambulation, incidence of cesarean section, instrumental delivery, side effects, and total dose of bupivacaine and fentanyl used were recorded. Results: Onset of analgesia in CSE group (1.48 ± 0.46 min) was significantly faster compared to the epidural group (3.87 ± 0.83 min). Duration of the first stage of labor was shorter in the CSE group (218.93 ± 78.15 min) compared to epidural group (308.03 ± 147). No significant difference between the groups was found in hemodynamic effects, duration of the second stage of labor, or in maternal and neonatal outcomes. Pruritus was seen in 50% of CSE patients. Mean total bupivacaine used in CSE group was significantly lesser than that used in Group I (56.750 ± 22.33 mg vs. 79.325 ± 28.81 mg). Conclusion: Both CSE and epidural analgesia provide comparable pain relief and maternal and fetal outcomes. CSE can be beneficial for parturients coming in advanced labor as its onset of action is faster.