Table 1.

Advantages and disadvantages of epidural, combined spinal–epidural, and dural puncture epidural analgesia. ? indicates some degree of uncertainty. FHR, fetal heart rate

Epidural	Combined spinal epidural (CSE)	Dural puncture epidural (DPE)
Advantages	Advantages	Advantages
Default technique/long history	‘Anatomical’ confirmation of epidural placement	‘Anatomical’ confirmation of epidural placement
Less equipment/less expensive	Faster analgesia	Stable haemodynamics
Stable haemodynamics	Improved analgesia?	Faster analgesia?
‘Proven’ catheter effect?	Better second stage analgesia	Improved analgesia?
	↓ Accidental dural punctures?	Better second stage analgesia?
	Increased maternal satisfaction	↓ Accidental dural punctures?
	Useful in training environment	Useful in training environment
	↓ Need for catheter replacement
Disadvantages	Disadvantages	Disadvantages
No objective determination of epidural space	↑ Paraesthesia (spinal needle)	Larger spinal needle (25G) needed?
Unreliable second-stage analgesia	↑ Pruritus	↑ Paraesthesia (spinal needle)
	↑ FHR effects (hypotension, ↑ uterine tone)	Dural puncture for no purpose?