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Tytuł pozycji:

Combined spinal epidural for labour analgesia and caesarean section: indications and recommendations.

Tytuł:
Combined spinal epidural for labour analgesia and caesarean section: indications and recommendations.
Autorzy:
Guasch E; Department of Anaesthesia and Reanimation, Maternal Hospital, Hospital Universitario La Paz.
Brogly N; Department of Anaesthesia and Reanimation, Maternal Hospital, Hospital Universitario La Paz.
Gilsanz F; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
Źródło:
Current opinion in anaesthesiology [Curr Opin Anaesthesiol] 2020 Jun; Vol. 33 (3), pp. 284-290.
Typ publikacji:
Journal Article; Review
Język:
English
Imprint Name(s):
Publication: Philadelphia, PA : Lippincott Williams & Wilkins
Original Publication: Philadelphia, PA, USA : Gower Academic Journals, c1988-
MeSH Terms:
Analgesia, Epidural*/adverse effects
Analgesia, Obstetrical*/adverse effects
Anesthesia, Spinal*/adverse effects
Anesthetics, Combined/*administration & dosage
Anesthesia, Obstetrical ; Cesarean Section ; Epidural Space ; Female ; Humans ; Pregnancy
References:
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Substance Nomenclature:
0 (Anesthetics, Combined)
Entry Date(s):
Date Created: 20200507 Date Completed: 20200625 Latest Revision: 20210125
Update Code:
20240105
DOI:
10.1097/ACO.0000000000000866
PMID:
32371639
Czasopismo naukowe
Purpose of Review: Even if its use is scarce in most countries, many articles concerning combined spinal epidural (CSE) were published. In this review, we present the latest advances concerning CSE in obstetrics.
Recent Findings: During labour, CSE improves epidural analgesia quality. Epidural with intradural opioids can produce maternal hypotension and foetal heart rate abnormalities (FHR-Ab), without increasing the caesarean section rate. For caesarean section, CSE decreases the neuraxial block failure rate, with no significant increase of complications. Epidural volume extension (EVE) after CSE for caesarean section could be an interesting option even though more evidence is needed.
Summary: For labour analgesia, CSE has the fastest onset time of analgesia. Its side effects have no consequences on maternal, labour or foetal outcomes. It provides better analgesia than epidural analgesia and can be used for external cephalic version and high-risk patients. For caesarean section, CSE has become the reference neuraxial technique for low-dose spinal anaesthesia, with higher success rate compared with regular spinal anaesthesia. Recent systematic revisions did not confirm this superiority. CSE offers the advantage of EVE, intraoperative top-ups, postoperative administration of neuraxial opioids and local anaesthetics. The risk of complications is balanced by the benefits of the technique.

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