Randomised comparison of combined spinal-epidural and standard epidural analgesia in labour

Epidural analgesia has a well-established role in labour, but has the drawbacks of delayed onset and motor blockade. The combined spinal-epidural technique may overcome these drawbacks. We carried out a randomised observational study to assess maternal satisfaction with the standard and combined techniques among 197 women in labour. For combined spinal-epidural analgesia, bupivacaine (2·5 mg) and fentanyl (25 μg) were initially injected into the subarachnoid space, followed by top-ups of 15 mL 0·1% bupivacaine with 2 μg/mL fentanyl into the epidural space, as required. For standard epidural analgesia, 25 mg (10 mL of 0·25%) bupivacaine was injected into the epidural space, followed by top-ups of 6-10 mL 0·25% bupivacaine, as required. Post partum, each woman completed a questionnaire about her labour and scored various items on a visual analogue scale (0=best, 100=worst outcome). Overall satisfaction was greater in the combined spinal-epidural group than in the standard epidural group (median [IQR] score 3 [2-10] vs 9 [3-22]; p=0·0002). Good analgesia was achieved in both groups, but the combined spinal-epidural had faster onset of analgesia and more of this group were satisfied with analgesia at 20 min (92/98 vs 68/99, p