Prophylactic intravenous ephedrine to minimize fetal bradycardia after combined spinal-epidural labour analgesia: a randomized controlled study.

Background: The combined spinal-epidural (CSE) technique for relief of labour pain offers both rapid onset and superior first-stage analgesia. Nevertheless, the known increased risk for early profound fetal bradycardia (EPFB) following CSE continues to be a concern that often limits its use. The purpose of this study was to determine if giving prophylactic intravenous ephedrine at the time of CSE administration would reduce EPFB.

A randomized controlled comparison of epidural analgesia and combined spinal-epidural analgesia in a private practice setting: pain scores during first and second stages of labor and at delivery.

Background: There has been no prospective evaluation of combined spinal-epidural (CSE) analgesia in a private practice setting and few studies have focused on pain relief during the second stage of labor and at delivery. In this randomized controlled trial, we compared verbal pain scores during the first and second stages of labor and at delivery in women receiving CSE or traditional epidural analgesia at a busy private maternity hospital.

Methods: Healthy, term parturients received epidural or CSE analgesia for labor pain upon request.

Lumbar ultrasound: useful gadget or time-consuming gimmick?

Despite widespread enthusiasm for using lumbar ultrasound in obstetrics, there are some who believe it is expensive and time-consuming, with undetermined risks and uncertain benefits. For decades, anesthesiologists have striven to perfect the identification and cannulation of the epidural space using skills learned during training and early clinical practice. These skills include knowledge of the relevant anatomy and detection of subtle tactile clues that aid successful placement of an epidural catheter.