DO OBSTETRIC OUTCOMES DIFFER BETWEEN EARLY COMBINED SPINAL-EPIDURAL AND EPIDURAL ANESTHESIA IN SPONTANEOUSLY LABORING NULLIPAROUS PATURIENTS?

Abstract

S382 Introduction: Previous studies showed that combined spinal-epidural (CSE) labor anesthesia in nulliparous parturients receiving oxytocin may differ from epidural anesthesia alone (EA) by shorter 2nd stage labor, less epidural local anesthetic requirement, and possibly less instrument deliveries. This prospective double-blinded, randomized study aims to see if these same differences between CSE and EA occur in spontaneously laboring nulliparous parturients as in induced laboring parturients. Methods: After IRB approval, informed consent was obtained from 22 healthy spontaneously laboring nulliparous term parturients with singleton fetus in vertex presentation and cervical dilation less than 5 cm, who requested regional labor analgesia. Patients were randomized to receive either CSE (n=11) or EA alone (n=11). CSE group received 35 ug fentanyl intrathecally after identification of intrathecal space by return of cerebral spinal fluid via 25 G Sprotte spinal needle. An epidural catheter was inserted but not tested or dosed until patient requested for more analgesia. EA groups received epidural anesthesia in usual manner For both CSE and EA groups, and the testing of epidural catheter consisted of 3 cc of 2% lidocaine with epinephrine and then dosed with 0.25% bupivacaine to T-10 level. After testing of epidural catheter, both groups received epidural PCA (EPCA) with 0.125% bupivacaine and 2 ug/cc of fentanyl. EPCA basal rate was 4 ml/hr with demand dose of 3ml every 8 mins. Additional bolus of 0.25% bupivacaine in 5 cc increments (up to a maximum of 10 cc) were administered if needed after maximal use of the EPCA. Patients were evaluated every 10 minutes for the first 30 minutes, then hourly. Data analysis included Chi square, ANOVA and unpaired t-test. Results: Demographics were similar between groups. Our results showed that there were no difference in the progress of labor, the amount of epidural local anesthetic required and the incidence of instrument deliveries between CSE and EA groups in the spontaneously laboring nulliparous parturients. However, CSE group had a more complete analgesia and a higher patient satisfaction than EA group. Discussion: Labor requiring oxytocin is at risk for dysfunction labor and may be more susceptible to adverse effects (if any) of EA than spontaneous labor. Therefore, previously reported differences between EA and CSE in induced laboring patients are not seen in spontaneously laboring patients here. (Table 1)Table 1