History

Background: neuraxial techniques for labor have consistently be used for alleviation of labor pain. The use of combined spinal epidural (CSE) has gained popularity as an alternative to conventional epidural techniques, although several challenges and debate exist regarding its impact on labor progress, mood of delivery and neonatal outcome. Objective: To detect the clinical effects of labor CSE analgesia in terms of analgesic efficacy and degree of motor block and its impact of labor, of delivery and neonatal outcome . Method: A case control study enrolled 200 women in active labor :100 parturients received CSE analgesia(Group I), and 100 others who did not receive neuraxial labor analgesia (Group II) . In the CSE group, analgesia was provided utilizing a combination of 2.5 mg of 0.5% plain bupivacaine and 25 Mcg fentanyl. Throughout labor, sensory level, motor block, pain scores and side effects were assessed, in addition to duration of active first stage and second stage of labor, mode of delivery and Apgar scores of babies at 1st and 5th minutes. Data then was analyzed statistically. Results: There was no statistically significant difference regarding Apgar score at 1st and 5th minutes in both groups. The rates of normal, instrumental vaginal deliveries and emergency lower segment cesarean section did not significantly differ between the two groups. Pruritis was present in 23% of CSE group and 4 cases develop hypotension. In the CSE group there was no case recorded to have high pain scores at the end of first and second stages of labor, whereas all parturients in the control group that had undergone NVD had high pain assessment scores throughout labor, this was reflected statistically to be significant as P value was 0.00. There is a significant reduction in duration of active first stage of labor in nulliparous cases of the CSE group compared to the control group (P value 0.01). The mean duration of the second stage of labor in nulliparous and multiparous cases of both groups was comparable. Conclusion: 1-The study concludes that CSE analgesia provides rapid onset of effective analgesia with no or minimal motor block promoting maternal satisfaction and does not impede the progress of labor nor depress the newborn. 2-Maternal pruritis is the most commonly observed side effect.