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Spinal, Epidural, and Combined Spinal Epidural Techniques: A Comparison
by Sanjay Datta, MD

Continuous Spinal Anesthesia/Analgesia Epidural Analgesia Combined Spinal Epidural Anesthesia
Simple and rapid Complex; more difficult to ensure proper placement of epidural needle Complex, but easier to ensure proper placement of epidural needle than with the epidural analgesia technique
Dural puncture is part of the procedure, resulting in greater incidence of headache Dural puncture is avoided if possible, resulting in fewer incidence of headache Dural puncture is made with a very small needle the shape of a pencil point; however, the combination of the spinal and epidural techniques results in fewer incidence of headache
Minimal amount of drug administered; therefore, less drug is absorbed by both the mother and the baby Larger quantity of drug is administered, resulting in higher levels of the drug in both the mother and the baby, but still within safe limits Minimal amount of drug is administered; therefore, less drug is absorbed by both the mother and the baby
Mother remains awake Mother remains awake Mother remains awake
Drop of blood pressure is common, resulting in nausea and vomiting; immediate treatment of drop in blood pressure is necessary Drop of blood pressure is uncommon, resulting in few incidence of nausea and vomiting Drop of blood pressure is uncommon, resulting in few incidence of nausea and vomiting
Quick onset Slow onset Quick onset
Immediate loss of sensory and motor power, which may be uncomfortable for some mothers Sensory and motor loss are gradual Sensory and motor loss are gradual and uncommon

Copyright 2001 by Sanjay Datta, MD, excerpt from Childbirth and Pain Relief, reprinted with permission of the publisher, Next Decade, Inc.

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