Sia A T, Camann W R, Ocampo C E, Goy R W, Tan H M, Rajammal S
Department of Anaesthesia (O&G), KK Women's and Children's Hospital, 100 Bukit, Singapore 229899.
Singapore Med J. 2003 Sep;44(9):464-70.
Apart from conventional epidural analgesia (EA), the combined spinal-epidural (CSE) modality is fast becoming a popular technique for treating labour pain. In this study, we investigated the differences in the patient profile and outcome between CSE and EA for labour pain in KK Women's and Children's Hospital.
Data pertaining to 1,532 healthy parturients who had received either CSE or EA for labour pain during a six-month period was systematically collected by using a specially designed form. Multiple logistic regression analysis was used to determine the independent predictors of patient satisfaction and the relation of parturient factors on the choice of block. The side effects and the outcome of labour were also compared.
CSE accounted for 80% of all neuraxial blocks performed for labour analgesia (vs 20% for EA). Anaesthesiologists were more inclined to using CSE than EA for multiparous parturients (OR 2.03, p<0.01) in a more painful (OR=1.61, p=0.03) and advanced stage of labour (OR=1.12, p=0.03). The need for supplemental analgesics was greater for EA (p<0.01). Patient satisfaction was higher for CSE (OR=1.77, p<0.026). CSE had a higher risk of pruritus (29% vs 14%, p<0.01) but lower risk of post block neural deficits (0% vs 2%, p<0.01) than EA. No difference in the mode of delivery was detected between the two groups.
CSE is a safe and good alternative to EA as a technique of neuraxial block for labour analgesia.
除传统的硬膜外镇痛（EA）外，腰麻-硬膜外联合麻醉（CSE）模式正迅速成为治疗分娩疼痛的常用技术。在本研究中，我们调查了新加坡KK妇女儿童医院采用CSE和EA治疗分娩疼痛时患者情况及结局的差异。
采用专门设计的表格，系统收集了1532名在六个月期间接受CSE或EA分娩镇痛的健康产妇的数据。使用多元逻辑回归分析来确定患者满意度以及产妇因素与麻醉方式选择之间关系的独立预测因素。还比较了两组的副作用和分娩结局。
CSE占所有用于分娩镇痛的椎管内阻滞的80%（而EA为20%）。对于经产妇，麻醉医生更倾向于使用CSE而非EA（比值比2.03，p<0.01），且在疼痛程度更高（比值比=1.61，p=0.03）和产程更晚期（比值比=1.12，p=0.03）时亦是如此。EA组对补充镇痛药的需求更大（p<0.01）。CSE组患者满意度更高（比值比=1.77，p<0.026）。与EA相比，CSE发生瘙痒的风险更高（29%比14%，p<0.01），但发生阻滞后期神经功能缺损的风险更低（0%比2%，p<0.01）。两组之间的分娩方式无差异。
作为一种用于分娩镇痛的椎管内阻滞技术，CSE是EA的一种安全且良好的替代方法。
