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Author Topic: Does any one practiced combined spinal epidural in normal labour analgesia?  (Read 3508 times)

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amorrahk

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do u have any experience about combined spinal opioid (what is the volume and concentration) epidural (anethetic) in analgesia of normal labour? :)
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yogenbhatt1

  • Yogen Bhatt, Mumbai, India
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    We used to give spinal Bupivacain Heavy 0.5 % 0.2 ml and 30mcg Fentanyl followed by Epidural management. We used to give it for a fast action.
   Later we gave up the method. Almost all patients were getting severe spinal headache. May be they lost a lot of CSF
 with each contraction and leaked a lot.
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amorrahk

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do u mean there is leake with the combined needle (needle through needle technique)? as the spinal needle gauge is 27? is the contraction predispose to csf leak throught the very small tear??
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yogenbhatt1

  • Yogen Bhatt, Mumbai, India
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We have always used saperate needle and space( Economy). It is always a 26 G needle. But it was our observation that all patients had PDPH. So much that the obstn. used to object to the method. I agree with you, that leak may not be there.
Regards
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kalpesh shah

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Hi, sir i regularly use CSE for labour analgesia.
 Incidence of PDPH is not realy vary high.
 Infact the perineal analgesia largely unsatisfactory in only epidural technique. 
Lots of international publication supports this perticular technique.

REGARDS.
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dimple parekh

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I DO USE 26 G SPINAL NEEDLE ,COMBINED WITH EPIDURAL IN SEPARATE OR SAME SPACE .SPINAL DOSE IS 25-50 MICS OF FENTANYL.NO PDPH.
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shivdatta

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We practice CSE routinely in our hospital. The plan is that if the pt comes with >3 contractions / 10 min we give it. This is because if it is less, then a pure epidural give adequate relief. At that time pts require fast releif and 25 mics of fentanyl is good for that
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dr kozlov

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i routinely give cse for labor, no matter how early in labor, bup 0.5 ml 0,75% in dextrose in spinal (for sacral block for 2nd stage) ,remove spinal needle, then 2-3 ml lido 1.5%  thru epidural needle(kicks in faster and expand epidural space), then pass cetheter , then 3 ml lido 1.55 with epi (as test dose and enough for fast pain relief) ,then when test dose is neg   and 7min after spinal passed (for  sacral block for 2nd stage to settle in) , 10 ml bup 0.0625% fent 2 mcg per cc,and continue pump same concentration 12 ml per hour----they feel contraction, no pain, can deliver without shutting off the pump
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