Advances in obstetric anesthesia: ambulation during labor with combined spinal-epidural analgesia

Abstract

Epidural analgesia is widely considered as the most effective method of providing pain relief in labor. However, epidural labor analgesia is not a generic procedure and many technical modifications have been invented over time. Continuous search for a balanced labor analgesia, which provides relief of pain of contractions while preserving motor function, has led to the development of the ambulatory labor analgesia. The combined spinal-epidural analgesia (CSEA) performed with subarachnoid opioids (with or without local anesthetics) causes minimal motor block and is particularly applicable to ambulatory labor analgesia. While there still remains some concern about dural puncture, the CSEA technique offers many advantages to the parturient, and has gained wide spread popularity in obstetric anesthesia worldwide.