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Chapter 25. Combined Spinal-Epidural Anesthesia
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Which of the following is an advantageous reason to choose combined spinal-epidural (CSE) over conventional epidural analgesia for labor?
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A. Conventional epidural analgesia lengthens the first stage of labor.
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B. CSE shortens the total duration of labor.
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C. CSE causes less motor block than conventional epidural analgesia.
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D. CSE is the only technique that allows the parturient to ambulate during labor analgesia.
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E. Local anesthetic (LA) requirement is lower in CSE.
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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).
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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.
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B is incorrect. Studies found that total duration of labor was within the same reference range for both CSE and conventional epidural analgesia.
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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.
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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
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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?
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A. CSE allows for a quicker discharge due to lower anesthetic dosing.
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B. CSE provides less motor block.
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C. There is a lower potential for anesthetic toxicity compared to conventional epidural.
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D. Sequential CSE allows for a wider safety margin regarding hemodynamics.
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E. None of the above is a known benefit of CSE.
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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 ...