Comparison of 2 techniques for combined spinal-epidural analgesia for advanced labor in childbirth

OBJECTIVES: To assess whether using a needle-locking device in combined spinal-epidural analgesia leads to better quality of pain relief for advanced stages of obstetric labor than can be achieved with conventional materials. PATIENTS AND METHODS: A total of 230 women in advanced labor were randomized to 2 groups. In both groups the needle-through-needle technique was used. In group N we used a new technique with a Tuohy needle and a system for locking the spinal needle (27-gauge, pencil-point design). The conventional technique (group C) made use of the same Tuohy needle and spinal needle without the needle-locking device. The variables considered were patient characteristics, anesthesiologist, number of attempts and level of difficulty in carrying out the procedure, pain on a simple verbal visual analog scale before the procedure and 5 minutes later, latency, motor block, duration of spinal analgesia, complications, type of expulsion, and maternal satisfaction. RESULTS: The 2 groups were similar with respect to all studied variables except duration of spinal analgesia (longer in group N, P<0.001); VAS after 5 minutes (lower in group N, P<0.010); latency (shorter in group N, P<0.001); lateralization (less in group N, P=0.034), and maternal satisfaction (greater in group N, P=0.037). CONCLUSIONS: The use of devices specifically designed for administering combined spinal-epidural analgesia in advanced stages of labor provides faster pain relief, longer duration of analgesia, and greater maternal satisfaction without increasing the incidence of complications.