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Summary
We have compared continuous spinal analgesia with continuous epidural analgesia for
pain relief in labour. Twenty-six women were randomly allocated to receive either
epidural 0.25% bupivacaine 5–10 ml via a 20 gauge catheter inserted through a 16 gauge
Tuohy needle or intrathecal 0.25% bupivacaine 0.5–1.0 ml via a 32 gauge catheter inserted
through a 24 gauge Sprotte needle. This was supplemented with fentanyl 5–10 mcg (spinal)
or 1 mcg per kg (epidural) if analgesia was unsatisfactory. Outcome was measured by
the success and timing of the procedure, time to analgesia, amount of drug given,
visual analogue scoring of pain relief by the patient and an observer and degree of
motor block. Onset time and dosage were significantly reduced in the continuous spinal
group. Two catheters failed to feed in the spinal group. One catheter became displaced
in each group. Pain relief was satisfactory in all patients and none had post-dural
puncture headache. Continuous spinal analgesia may offer significant advantages over
epidural analgesia but technical difficulties remain with the present equipment. The
reasons for the withdrawal of the spinal catheters in the United States of America
are discussed.
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© 1995 Pearson Professional Ltd. Published by Elsevier Inc.
