Complications Associated With Spinal Migration of the Epidural Catheter
CONTROVERSIAL TOPICS IN CSE TECHNIQUE
Combined spinal epidural versus epidural analgesia
Conventional epidural analgesia has disadvantage of slow onset and higher rate of instrumental delivery while spinal anaesthesia in standard doses causes hypotension and bradycardia which might further compromise critical foetal condition. Combined spinal- epidural (CSE) analgesia with low dose of intrathecal local anaesthetic or/and opioid offers theoretical advantages of faster onset and lower incidence of side effect associated with standard spinal anaesthesia.
CSE analgesia offers advantages in some clinical situations. Overall…show more content… CSE anaesthesia seems to be particularly suitable for caeserean section in parturiens with significant cardiac comorbidities like aortic stenosis or Eisemenger syndrome due to less haemodynamic compromise.
Although in the latest Cochrane database research of clinical trials, CSE technique was not found superior to standard epidural analgesia, it might have advantages in some subgroups of obstetric patients. There was no difference in mother satisfaction, mobility, mode of delivery, maternal hypotension postdural puncture headache and neonatal outcome. The conclusion was that at the moment there is not enough evidence to offer CSE over epidural.
Haemodynamic instability, although less pronounced than in conventional spinal anaesthesia, might be of clinical relevance, as well. reduced mobility due to motor effects of local anaesthetics which can cause discomfort and reduce maternal…show more content… However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia. In conclusion CSE analgesia during the first stage of labour does not increase FHR abnormalities or have an adverse effect on neonatal or obstetric outcomes when compared with epidural analgesia. There was no difference in the incidence of suspicious or pathological FHR traces, neonatal outcome as assessed by Apgar scores or umbilical artery and vein pH and base excess or obstetric outcome between the two neuraxial techniques.(20)
Meta-analysis by Hattler and college comparing the incidence of nonreassuring FHR tracings between the 2 neuraxial techniques. Combined spinal–epidural labor analgesia was associated with a higher risk of nonreassuring FHR tracings than epidural analgesia alone. But cannot be concluded that there was no difference between combined spinal–epidural and low-dose epidural
