Comparison of combined spinal-epidural block versus epidural block for labor analgesia: a meta analysis / 中华麻醉学杂志

ABSTRACT

Objective To systematically compare the combined spinal-epidural block versus epidural block for labor analgesia.Methods PubMed,Embase,Cochrane Library and Web of Science were searched for randomized controlled trials involving the comparison of combined spinal-epidural block versus epidural block for labor analgesia from the date of database establishment up to September 2016.Evaluation indexes included visual analog scale scores (at 5,10 and 15 min after analgesia),onset time of analgesia,duration of analgesia,duration of the second stage of labor,cesarean section and assisted vaginal delivery,development of Apgar scores of the neonates＜7 (at 1 and 5 min after birth) and occurrence of adverse reactions.The quality of the trials was evaluated according to Cochrane Handbook 5.1.0 criteria,and meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.3 software.Results Twenty studies involving 6 297 patients were included in this meta-analysis.Compared with group epidural block,visual analog scale scores were significantly decreased at 5,10 and 15 min after analgesia,the onset time of analgesia was shortened,and the incidence of pruritus and hypotension was increased in group combined spinalepidural block (P＜0.05).Conclusion Compared with epidural block,although the combined spinalepidural block has faster onset,the adverse effects are more when used for labor analgesia.