Combined spinal epidural analgesia vs standard epidural analgesia : delaying onset and motor blockade

Abstract

This research was conducted to investigate whether standard epidural causes less risk of delayed onset of pain relief and motor blockade when compared to combined spinal epidural. The study’s PICO question was the following: “In women undergoing labour and delivery, does combined spinal epidural analgesia cause less risk of delayed onset and motor blockade when compared to standard epidural analgesia?” The Population (P) consisted of women undergoing labour, while the Intervention (I) was the administration of standard analgesia and CSE, and the Comparison (C) was the lesser motor blockade and faster onset between standard epidural analgesia and CSE. Finally, the Outcome (O) was determining the best analgesic technique in terms of motor blockade and faster onset. The inclusion criteria were literature published in the last 26 years, full-text literature, studies in English, RCTs, meta-analyses, systematic reviews, administration of analgesia by healthcare teams, effects of CSE and standard epidural on the mother, and studies conducted on human beings. The exclusion criteria included literature published before 1995, literature displaying abstracts only, studies in different languages, case control studies, expert opinions, patient-controlled analgesia, and effects of CSE and standard epidural on the foetus. Six studies met the inclusion and exclusion criteria, and were thus included in this study. The CASP tool was used for the critical appraisal of the selected studies. The primary outcome was faster onset and less motor blockade of both analgesics, while the secondary outcome was the side effects of both epidural techniques. The main findings obtained from this study and the critical appraisal demonstrated that there are no statistical differences between both epidural analgesics. However, combined spinal epidural causes a faster onset and decreases motor blockade in the first period of administration and in the first stages of labour; nonetheless, in the following stages, no significant differences were found. Therefore, more research needs to be conducted to compare standard analgesia with combined spinal epidural.