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Chapter 25. Combined Spinal-Epidural Anesthesia

Which of the following is an advantageous reason to choose combined spinal-epidural (CSE) over conventional epidural analgesia for labor?

A. Conventional epidural analgesia lengthens the first stage of labor.

B. CSE shortens the total duration of labor.

C. CSE causes less motor block than conventional epidural analgesia.

D. CSE is the only technique that allows the parturient to ambulate during labor analgesia.

E. Local anesthetic (LA) requirement is lower in CSE.

C is correct. CSE has been proven to cause less motor weakness than does conventional epidural analgesia. Even though this is true for analgesia for labor, CSE is known to cause a more profound motor block compared to conventional epidural when used for surgical intervention (eg, knee or hip arthroplasty).

A is incorrect. CSE has been proven to shorten the first stage of labor, but conventional epidural analgesia has not been proven to lengthen this stage.

B is incorrect. Studies found that total duration of labor was within the same reference range for both CSE and conventional epidural analgesia.

D is incorrect. Though patients who received CSE can ambulate during labor depending on the dose and drug they received, other techniques may also allow the parturient to ambulate.

E is incorrect. Although LA requirement is lower for the initial dose in CSE, Patel et al reported that the epidural minimal local anesthetic concentration (MLAC) of bupivacaine increased by a factor 1.45 when intrathecal medication (CSE) was administered. It seems that the dosage-reduction advantage of CSE does not extend past the initial epidural dose.1

A 43-year-old woman with hypertension and hypercholesterolemia is scheduled to undergo anterior cruciate ligament reconstructive surgery in an ambulatory surgery setting. Which of the following is not a benefit of combined spinal-epidural (CSE) compared to single-shot spinal (SSS) or conventional epidural?

A. CSE allows for a quicker discharge due to lower anesthetic dosing.

B. CSE provides less motor block.

C. There is a lower potential for anesthetic toxicity compared to conventional epidural.

D. Sequential CSE allows for a wider safety margin regarding hemodynamics.

E. None of the above is a known benefit of CSE.

B is correct. Less motor block is not a benefit of combined spinal-epidural (CSE). Numerous studies have proven CSE to cause a more profound motor block during surgery. The differences in dosing and drugs used for ...

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