Meta-analysis of the success of block following combined spinal-epidural vs epidural analgesia during labour
| Autor: | M. Van de Velde, Sebastian Straube, Michael Heesen, S. Klöhr, Rolf Rossaint, J. Lehberger |
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| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
Anesthesia Spinal law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial 030202 anesthesiology law Pregnancy medicine Humans 030212 general & internal medicine Vein Labor Obstetric business.industry Surgery Analgesia Epidural Epidural catheter Anesthesiology and Pain Medicine Combined spinal epidural medicine.anatomical_structure Relative risk Anesthesia Meta-analysis Analgesia Obstetrical Observational study Female Best evidence business |
| Zdroj: | Anaesthesia. 69(1) |
| ISSN: | 1365-2044 |
| Popis: | Observational studies suggest that combined spinal-epidural analgesia (CSE) is associated with more reliable positioning, lower epidural catheter replacement rates, and a lower incidence of unilateral block compared with epidural analgesia. However, evidence from high-quality trials still needs to be assessed systematically. We performed a systematic review that included 10 randomised controlled trials comparing CSE and epidural analgesia in 1722 labouring women in labour. The relative risk of unilateral block was significantly reduced after CSE vs epidural analgesia (0.48, 95% CI 0.24-0.97), but significant between-study heterogeneity was present (I(2) = 69%, p = 0.01). No differences were found for rates of epidural catheter replacement, epidural top-up, and epidural vein cannulation. On the basis of current best evidence, a consistent benefit of CSE over epidural analgesia cannot be demonstrated for the outcomes assessed in our review. A large randomised controlled trial with adequate power is required. |
| Databáze: | OpenAIRE |
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