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Meta‐analysis of the success of block following combined spinal‐epidural vs epidural analgesia during labour
Author(s) -
Heesen M.,
Van de Velde M.,
Klöhr S.,
Lehberger J.,
Rossaint R.,
Straube S.
Publication year - 2014
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.12456
Subject(s) - medicine , epidural block , combined spinal epidural , anesthesia , meta analysis , observational study , catheter , randomized controlled trial , surgery
Summary Observational studies suggest that combined spinal‐epidural analgesia ( CSE ) is associated with more reliable positioning, lower epidural catheter replacement rates, and a lower incidence of unilateral block compared with epidural analgesia. However, evidence from high‐quality trials still needs to be assessed systematically. We performed a systematic review that included 10 randomised controlled trials comparing CSE and epidural analgesia in 1722 labouring women in labour. The relative risk of unilateral block was significantly reduced after CSE vs epidural analgesia (0.48, 95% CI 0.24–0.97), but significant between‐study heterogeneity was present (I 2 = 69%, p = 0.01). No differences were found for rates of epidural catheter replacement, epidural top‐up, and epidural vein cannulation. On the basis of current best evidence, a consistent benefit of CSE over epidural analgesia cannot be demonstrated for the outcomes assessed in our review. A large randomised controlled trial with adequate power is required.