28. (6.) Results by individual review ‐ combined spinal epidural.
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6. Combined spinal‐epidural versus epidural in labour, 27 studies, 3303 women (Simmons 2012) | |||
| Combined spinal‐epidural versus traditional epidural | Outcome | No. of studies (no. women) | Results |
| Pain intensity – time from first injection to effective analgesia in minutes | 2 (129) | MD ‐2.87, 95% CI ‐5.07 to ‐0.67, CSE had a faster onset time of effective pain relief from time of injection (approximately 3 minutes) |
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| Satisfaction with pain relief | Outcome not reported | ||
| Sense of control in labour | Outcome not reported | ||
| Satisfaction with childbirth experience | Outcome not reported | ||
| Effect on mother/baby interaction | Outcome not reported | ||
| Breastfeeding | Outcome not reported | ||
| Assisted vaginal birth | 6 (1015) | RR 0.80, 95% CI 0.67 to 0.97, fewer assisted vaginal births in the CSE group | |
| Caesarean section | 6 (1015) | RR 1.04, 95% CI 0.84 to 1.30, no evidence of a significant difference between groups | |
| Adverse effects for women (post dual puncture) | 3 (188) | RR 3.78, 95% CI 0.16 to 89.09, no evidence of a significant difference between groups | |
| Adverse effects for women (known dural tap) | 3 (842) | RR 2.77, 95% CI 0.66 to 11.65, no evidence of a significant difference between groups | |
| Adverse effects for women (pruritus) | 6 (370) | Average RR 7.34, 95% CI 0.14 to 375.82, (random effects; heterogeneity: I2 = 97%, Tau2 = 15.29, Chi2 test for heterogeneity P <0.00001), there was no significant difference between groups | |
| Adverse effects for women (urinary retention) | 1 (704) | RR 0.86, 95% CI 0.79 to 0.95, fewer women in the CSE group experienced urinary retention | |
| Adverse effects for women (nausea/vomiting) | 6 (370) | Average RR 1.48, 95% CI 0.55 to 3.95, (random effects; heterogeneity: I2 = 59%, Tau2 = 0.51, Chi2 test for heterogeneity P =0.06), no significant difference between groups | |
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Adverse effects for women (hypotension) | 6 (1002) | Average RR 0.81, 95% CI 0.65 to 1.02, no significant difference between groups |
| Adverse effects for women (headache) | 1 (79) | RR 1.03, 0.07 to 15.83, no significant difference between groups | |
| Adverse effects for women (sedation) | 1 (79) | RR 1.03, 0.46 to 2.31, no significant difference between groups | |
| Adverse effects for infants | Outcome not reported in suitable format | ||
| Admission to special care baby unit/neonatal intensive care | 1 (704) | RR 0.63, 95% CI 0.29 to 1.37, no significant difference between groups | |
| Apgar score less than seven at five minutes | 3 (842) | RR 2.10, 95% CI 0.63 to 6.97, no evidence of a significant difference between groups | |
| Poor infant outcomes at long‐term follow‐up | Outcome not reported | ||
| Cost | Outcome not reported | ||
| Combined spinal‐epidural versus low‐dose epidural | Outcome | No. of studies (no. women) | Results |
| Pain intensity – time from first injection to effective analgesia in minutes | 5 (461) | Average Mean difference MD ‐5.42, 95% CI ‐7.26 to ‐3.59, (random effects; heterogeneity: I2 = 77%, Tau2 = 3.27, Chi2 test for heterogeneity P =0.002), CSE had a faster onset time of effective pain relief from time of injection (approximately 6 minutes) | |
| Pain intensity – number of women with effective analgesia 10 minutes after first injection | 1 (101) | RR 1.94, 95% CI 1.49 to 2.54, more women in the CSE group had effective analgesia | |
| Satisfaction with pain relief | 7 (520) | RR 1.01, 95% CI 0.98 to 1.05, no significant difference between groups | |
| Sense of control in labour | Outcome not reported | ||
| Satisfaction with childbirth experience | Outcome not reported | ||
| Effect on mother/baby interaction | Outcome not reported | ||
| Breastfeeding | Outcome not reported | ||
| Assisted vaginal birth | 11 (1612) | RR 1.07, 95% CI 0.88 to 1.30, no evidence of a significant difference between groups | |
| Caesarean section | 15 (1960) | RR 0.97, 95% CI 0.82 to 1.16, no evidence of a significant difference between groups | |
| Adverse effects for women (post dual puncture) | 9 (701) | RR 1.68, 95% CI 0.42 to 6.81, no evidence of a significant difference between groups | |
| Adverse effects for women (known dural tap) | 6 (1326) | RR 0.81, 95% CI 0.22 to 2.98, no evidence of a significant difference between groups | |
| Adverse effects for women (number of women requiring blood patch for post dural puncture headache) | 7 (531) | RR 2.22, 95% CI 0.51 to 9.64, no evidence of a significant difference between groups | |
| Adverse effects for women (pruritus) | 11 (959) | Average RR 1.80, 95% CI 1.22 to 2.65, (random effects; heterogeneity: I2 = 84%, Tau2 = 0.26, Chi2 test for heterogeneity P <0.00001), more women in the CSE group had pruritus | |
| Adverse effects for women (urinary retention) | 4 (964) | RR 1.05, 95% CI 0.94 to 1.16, no evidence of a significant difference between groups | |
| Adverse effects for women (nausea/vomiting) | 7 (539) | Average RR 0.97, 95% CI 0.65 to 1.45, no evidence of a significant difference between groups | |
| Adverse effects for women (hypotension) | 14 (2040) | Average RR 1.35, 95% CI 0.89 to 2.04, (random effects; heterogeneity: I2 = 50%, Tau2 = 0.13, Chi2 test for heterogeneity P =0.04), no evidence of a significant difference between groups | |
| Adverse effects for women (headache any) | 1 (110) | RR 0.14, 0.01 to 2.70, no evidence of a significant difference between groups | |
| Adverse effects for infants | Outcome not reported in suitable format | ||
| Admission to special care baby unit/neonatal intensive care | 3 (852) | RR 0.77, 95% CI 0.34 to 1.73, no evidence of significant difference between groups | |
| Apgar score less than seven at five minutes | 6 (1092) | RR 0.70, 95% CI 0.31 to 1.59, no evidence of a significant difference between groups | |
| Poor infant outcomes at long‐term follow‐up | Outcome not reported | ||
| Cost | Outcome not reported | ||
CI: confidence interval; MD: mean difference; RR: risk ratio