Combined Spinal Epidural Analgesia in Labour

The combined spinal epidural (CSE) as an anaesthetic technique for providing analgesia for labour and anaesthesia for operative delivery has gained in popularity over the last ten years. Essentially the CSE consists of identification of the epidural space and insertion of an epidural catheter plus the initial intentional placement of an intrathecal dose of opioid, local anaesthetic or both, all as a single procedure. Theoretically the technique combines the advantages of the speed of onset and the reliability of block achieved by subarachnoid anaesthesia with the flexibility provided by the presence of an epidural catheter and avoids their individual disadvantages. The complications that may be encountered are those attributable to subarachnoid and epidural anaesthesia individually but some are unique to the CSE technique. The CSE technique is also applicable to other situations in obstetrics where a block is initiated by subarachnoid anaesthesia and its continuation is facilitated by the presence of an epidural catheter, either to maintain anaesthesia for prolonged procedures or for post operative pain control. The CSE's popularity has been ensured by the fact that it has allowed rapid onset analgesia with minimal motor blockade to be provided routinely for mothers in labour.