Combined spinal-epidural analgesia for labour pain relief: a narrative review

Abstract

Ensuring analgesia during labour is particularly important and often demanding. The goal of neuraxial labour pain management is to ensure high-quality analgesia, covering sensory loss from T10-S4 dermatomes and minimize motor blockade. Epidural techniques provide relief to the parturients and, with the administration of appropriate doses, allowed for mobilization and unimpeded extrusion of the fetus. However, there are various complications associated with the method. We are now faced with increased rates of epidural failure in the management of labour pain. Often, the block is inadequate or unilateral and a repositioning or even replacement of the catheter is required. Therefore, it seems necessary to develop techniques aimed at reducing the failure rates of epidural analgesia. The initiation of labour with combined spinal epidural analgesia presents multiple potential benefits. It can be used in parturients requiring stronger pain relief, has a faster onset of action, better drug diffusion and achieves better sacral block. In addition, it is possible to confirm the position of the epidural space through the spinal pencil point needle (needle-through-needle technique), resulting in lower rates of epidural failure and postdural puncture headache. By administering an opioid intrathecally, minimal sympathetic block is achieved. Therefore, under certain circumstances combined spinal epidural analgesia could be superior to epidural analgesia. Further studies are needed to search for the ideal analgesia technique for the relief of parturient pain during labour.