Single space combined spinal-extradural technique for analgesia in labour

Abstract

We have used the single space combined spinal-extradural technique for mothers requesting analgesia in labour. Intrathecal plain bupivacaine 5 mg produced a median time to analgesia of 3 min. There was inadequate abdominal analgesia after 10 min in 16% of recipients, although all had good perineal analgesia. The median height of block was T8 (range T4-L2) and mean duration of analgesia 72 (SD 21) min. Hypotension occurred in two of 30 mothers, but responded to fluids and ephedrine. There were no post-spinal headaches. This technique is suitable for those parturients requesting analgesia in active labour who may not have time to achieve extradural analgesia before delivery. The extradural catheter is used to improve analgesia if the subarachnoid block is inadequate, or if labour continues beyond the duration of the subarachnoid block.