Single dose spinal analgesia: Is it a good alternative to epidural analgesia in controlling labour pain?

Objectives: Regional anaesthesia is considered the optimal technique for obstetric patients; nevertheless, the optimal method of regional anaesthesia for delivery remains to be determined. In our study we investigate the safety, efficacy and cost benefits of single-dose spinal analgesia in comparison with epidural analgesia during labour. Study design: In our study women in advanced labour were randomly allocated into two equal groups using a computer-generated randomization table, one group (spinal group = S group) were given 3.75 mg hyperbaric bupivacaine +25 mu g fentanyl with 0.75 ml saline, the other group (Epidural group = E group) were given 4 ml bupivacaine with 4 ml saline and 1 ml (50 mu g) fentanyl pain intensity was recorded by the parturient on a visual analogue scale. The quality of pain relief was also rated with a verbal score directly after delivery. Side effects, such as hypotension, Pruritus, sedation, nausea and motor block were noted. Obstetric parameters were followed and recorded, Apgar score were noted, and all the results were compared in the two groups. Results: Onset of sensory block (detected by pin-prick test) was early (4.4 +/- 1.5 min vs 12.5 +/- 2.3 min, p < 0.001) and duration of sensory block was longer (120.4 +/- 15.6 vs 103.2 +/- 18.3 min, p < 0.001) in S group compared to E group, time to reach maximum dermatome level of sensory block (T-10) was shorter in S than E group (8.3 +/- 2.4 min vs 22.4 +/- 5.7 min, p < 0.001), two segment regression occur late in S group compared to E group(75.6 +/- 12.5 min vs 66.3 +/- 9.4 min, p < 0.001). Visual analogue scores after 5, 15, 30, 60, 90, 120 and 150 min were lower in S group compared to E group, all the previous result is statically significant (p < 0.001). 88% of the parturients in S group vs 60% in E group scored the analgesic quality as excellent, the mean duration of analgesia (Mean +/- SD) was longer in S group compared to E group. 8% of parturients in S group vs 14% of parturients in E group had hypotension. Motor block, sedation and nausea were 2-6% in both groups. Pruritus was seen in 60% in E group vs 25% in spinal one. No caesarean section was performed. Vacuum extraction was done in 15% vs 25% among S group and E group respectively. Oxytocin augmentation was needed in 48% vs 62% of the parturients among S group and E group respectively. Faetal heart rate disturbances following the spinal block were seen in 2 cases. Apgar score were high and no neonate had Apgar score < 7 in both group. The overall cost was lower in S group compared to E group. Conclusions: Based on the results of our study we concluded that single dose spinal analgesia is a good alternative to epidural analgesia in controlling labour pain i.e. spinal compared to epidural is more easy performed, faster, less expensive, and provide effective analgesia. (C) 2014 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists. Open access under CC BY-NC-ND license.