Low-dose spinal versus epidural anaesthesia for delivery and expected caesarean section

Regional anaesthesia is associated with significantlly lower mortality among obstetric patients, but the optimal technique for delivery and cesarean section remains to be determined. Conventional epidural analgesia has disadvantage of slow onset and higher rate of instrumental delivery while spinal anaesthesia in standard doses causes hypotension and bradycardia which might further compromise critical foetal condition. Combined spinal-epidural (CSE) analgesia with low dose of intrathecal local anaesthetic or/and opioid offers theoretical advantages of faster onset and lower incidence of side effect associated with standard spinal anaesthesia. The optimal intrathecal dose which balances effective analgesia and haemodynamic stability varies in literature. CSE anaesthesia seems to be particularly suitable for caeserean section in parturiens with significant cardiac comorbidites like aortic stenosis or Eisemenger syndrome due to less haemodynamic compromise. Therefore, although in the latest Cochrane database research of clinical trials, CSE technique was not found superior to standard epidural analgesia, it might have advantages in some subgroups of obstetric patients. The definitive role of low-spinal anaesthesia as a part of CSE in clinical practice remains to be clarified.