Combined spinal-epidural analgesia for laboring parturients in a Nigerian Hospital

Background: Awareness and demand for neuraxial pain relief for labor are on the increase, but epidural technique appears to be the preferred option among anesthetists in Nigeria. We describe our experience with combined spinale-pidural (CSE) analgesia to fill the gap in knowledge in order to boost its utilization. Materials and Methods: In this retrospective observational study, data were collected from the obstetric analgesia proforma completed for all CSE analgesia performed for labor pain relief between January 1, 2011 and June 30, 2014. Results: Thirty parturients (21 nulliparous: 9 parous) with a singleton gestation in labor with a mean age of 31.0 +/- 4.1 years were studied. In all, 56.7% of parturients requested for analgesia following oxytocin augmentation. The overall mean onset of analgesia and cervical os dilatation at initiation of analgesia were 2.23 +/- 0.43 min and 3.4 +/- 1.3 cm respectively, with no significant difference between groups. Overall analgesia was adequate in 90% of cases, and 76.7% had spontaneous vaginal delivery; although only nulliparous parturients (23.3%) had cesarean delivery, it was not significant (P = 0.07). There was a significant difference in Apgar score at 1-min between nulliparous and parous groups (7.7 vs. 8.9; P = 0.03), but no difference at 5-min. The side effects observed were vomiting and shivering. Conclusion: CSE technique can be safely used in every laboring parturient irrespective of parity either in early or late labor situations.