Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Almost two decades have passed since French and American trials evaluated the use of spinal opioids during labor and since European randomized trials compared conventional epidural analgesia with combined spinal epidural (CSE) analgesia. CSE analgesia has gained worldwide acceptance and is becoming increasingly popular for labor pain relief. Obstetric anesthetists are divided when questioned on the place of CSE in labor analgesia. Whilst some authors feel it should be the technique of choice, others reserve CSE for certain indications. Recently, Simmons et al. published a Cochrane review concluding that CSE offers little benefit as compared to conventional epidural analgesia. However, the authors of this metaanalysis did acknowledge that CSE produced faster analgesia, resulted in less need for rescue analgesia and was associated with less urinary retention. Apart from a slight increase in the incidence of pruritus, these beneficial effects were not associated with more complications. The three demonstrated benefits of CSE are sufficient to promotes it’s use if the side-effect profile remains unaltered. Furthermore it must be stressed that this Cochrane review can be criticized. Firstly, a number of well performed studies were excluded from (Rev. Esp. Anestesiol. Reanim. 2009; 56: 546-561) FORMACIÓN CONTINUADA