Cochrane CSEAvsEA4CS
.PDF
|
20.1 Combined spinal- |
3 |
846 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.02 [0.82, 1.28] |
|
epidural versus traditional |
|
|
|
|
|
epidural |
|
|
|
|
|
20.2 Opioid combined spinal- |
1 |
79 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.54 [0.27, 8.71] |
|
epidural versus traditional |
|
|
|
|
|
epidural |
|
|
|
|
21 |
Umbilical arterial pH |
1 |
55 |
Mean Difference (IV, Fixed, 95% CI) |
-0.02 [-0.06, 0.02] |
|
21.2 Opioid combined spinal- |
1 |
55 |
Mean Difference (IV, Fixed, 95% CI) |
-0.02 [-0.06, 0.02] |
|
epidural versus traditional |
|
|
|
|
|
epidural |
|
|
|
|
22 |
Umbilical venous pH |
1 |
55 |
Mean Difference (IV, Fixed, 95% CI) |
-0.03 [-0.06, -0.00] |
|
22.2 Opioid combined spinal- |
1 |
55 |
Mean Difference (IV, Fixed, 95% CI) |
-0.03 [-0.06, -0.00] |
|
epidural versus traditional |
|
|
|
|
|
epidural |
|
|
|
|
23 |
Umbilical cord pH |
0 |
0 |
Mean Difference (IV, Fixed, 95% CI) |
Not estimable |
24 |
Apgar score < 7 at 5 minutes |
3 |
842 |
Risk Ratio (M-H, Fixed, 95% CI) |
2.10 [0.63, 6.97] |
|
24.2 Opioid combined spinal- |
3 |
842 |
Risk Ratio (M-H, Fixed, 95% CI) |
2.10 [0.63, 6.97] |
|
epidural versus traditional |
|
|
|
|
|
epidural |
|
|
|
|
25 |
Apgar score < 8 at 5 minutes |
1 |
704 |
Risk Ratio (M-H, Fixed, 95% CI) |
2.35 [0.61, 9.00] |
|
25.1 Combined spinal- |
1 |
704 |
Risk Ratio (M-H, Fixed, 95% CI) |
2.35 [0.61, 9.00] |
|
epidural versus traditional |
|
|
|
|
|
epidural |
|
|
|
|
26 Number admitted to neonatal |
1 |
704 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.63 [0.29, 1.37] |
|
|
unit |
|
|
|
|
|
26.1 Combined spinal- |
1 |
704 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.63 [0.29, 1.37] |
|
epidural versus traditional |
|
|
|
|
|
epidural |
|
|
|
|
Comparison 2. Combined spinal-epidural versus low-dose epidural
Outcome or subgroup title |
No. of |
No. of |
Statistical method |
Effect size |
|
studies |
participants |
||||
|
|
|
|||
|
|
|
|
|
|
1 Time from first injection to |
3 |
285 |
Mean Difference (IV, Fixed, 95% CI) |
-5.59 [-6.59, -4.58] |
|
effective analgesia (minutes) |
|
|
|
|
|
1.1 Combined spinal-epidural |
3 |
285 |
Mean Difference (IV, Fixed, 95% CI) |
-5.59 [-6.59, -4.58] |
|
versus low-dose epidural |
|
|
|
|
|
2 Number of women with effective |
1 |
101 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.94 [1.49, 2.54] |
|
analgesia 10 minutes after first |
|
|
|
|
|
injection |
|
|
|
|
|
2.1 Combined spinal-epidural |
1 |
101 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.94 [1.49, 2.54] |
|
versus low-dose epidural |
|
|
|
|
|
3 Need for rescue analgesia |
7 |
1404 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.96 [0.77, 1.20] |
|
3.1 Combined spinal-epidural |
5 |
1087 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.93 [0.74, 1.17] |
|
versus low-dose epidural |
|
|
|
|
|
3.2 Opioid combined spinal- |
1 |
69 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.32 [0.01, 7.69] |
|
epidural versus test local |
|
|
|
|
|
anaesthetic/opioid epidural |
|
|
|
|
|
|
|
||||
Combined spinal-epidural versus epidural analgesia in labour (Review) |
38 |
||||
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
3.4 Null combined spinal- |
1 |
248 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.38 |
[0.64, 2.98] |
|
epidural versus low-dose |
|
|
|
|
|
|
epidural |
|
|
|
|
|
|
4 Number of women satisfied with |
5 |
420 |
Risk Ratio (M-H, Random, 95% CI) |
1.08 |
[0.93, 1.25] |
|
analgesia |
|
|
|
|
|
|
4.1 |
Combined spinal-epidural |
5 |
420 |
Risk Ratio (M-H, Random, 95% CI) |
1.08 |
[0.93, 1.25] |
versus low-dose epidural |
|
|
|
|
|
|
5 Number of women who mobilise |
6 |
1064 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.04 |
[0.92, 1.18] |
|
5.1 |
Combined spinal-epidural |
4 |
955 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.01 |
[0.88, 1.15] |
versus low-dose epidural |
|
|
|
|
|
|
5.2 |
Opioid combined spinal- |
2 |
109 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.28 |
[0.95, 1.74] |
epidural versus test local |
|
|
|
|
|
|
anaesthetic/opioid epidural |
|
|
|
|
|
|
6 Post dural puncture headache |
9 |
701 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.68 |
[0.42, 6.81] |
|
6.1 |
Combined spinal-epidural |
7 |
590 |
Risk Ratio (M-H, Fixed, 95% CI) |
3.06 |
[0.50, 18.69] |
versus low-dose epidural |
|
|
|
|
|
|
6.2 |
Opioid combined spinal- |
1 |
69 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.32 |
[0.01, 7.69] |
epidural versus test local |
|
|
|
|
|
|
anaesthetic/opioid epidural |
|
|
|
|
|
|
6.3 |
Opioid combined spinal- |
1 |
42 |
Risk Ratio (M-H, Fixed, 95% CI) |
Not estimable |
|
epidural versus low-dose |
|
|
|
|
|
|
epidural |
|
|
|
|
|
|
7 Known dural tap |
6 |
1326 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.81 |
[0.22, 2.98] |
|
7.1 |
Combined spinal-epidural |
4 |
1006 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.52 |
[0.10, 2.75] |
versus low-dose epidural |
|
|
|
|
|
|
7.2 |
Opioid combined spinal- |
1 |
69 |
Risk Ratio (M-H, Fixed, 95% CI) |
Not estimable |
|
epidural versus test local |
|
|
|
|
|
|
anaesthetic/opioid epidural |
|
|
|
|
|
|
7.4 Null combined spinal- |
1 |
251 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.95 |
[0.18, 21.26] |
|
epidural versus low-dose |
|
|
|
|
|
|
epidural |
|
|
|
|
|
|
8 Number of women requiring |
7 |
531 |
Risk Ratio (M-H, Fixed, 95% CI) |
2.22 |
[0.51, 9.64] |
|
blood patch for post dural |
|
|
|
|
|
|
puncture headache |
|
|
|
|
|
|
8.1 |
Combined spinal-epidural |
3 |
257 |
Risk Ratio (M-H, Fixed, 95% CI) |
4.85 |
[0.24, 97.11] |
versus low-dose epidural |
|
|
|
|
|
|
8.2 |
Opioid combined spinal- |
1 |
69 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.32 |
[0.01, 7.69] |
epidural versus test local |
|
|
|
|
|
|
anaesthetic/opioid epidural |
|
|
|
|
|
|
8.3 |
Opioid combined spinal- |
3 |
205 |
Risk Ratio (M-H, Fixed, 95% CI) |
5.45 |
[0.27, 111.13] |
epidural versus low-dose |
|
|
|
|
|
|
epidural |
|
|
|
|
|
|
9 Pruritus |
7 |
572 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.62 |
[1.34, 1.97] |
|
9.1 |
Combined spinal-epidural |
6 |
530 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.57 |
[1.29, 1.90] |
versus low-dose epidural |
|
|
|
|
|
|
9.3 |
Opioid combined spinal- |
1 |
42 |
Risk Ratio (M-H, Fixed, 95% CI) |
6.6 [0.87, 50.18] |
|
epidural versus low-dose |
|
|
|
|
|
|
epidural |
|
|
|
|
|
|
10 Urinary retention |
3 |
828 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.09 |
[0.98, 1.21] |
|
Combined spinal-epidural versus epidural analgesia in labour (Review) |
39 |
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. |
|
10.1 Combined spinal- |
2 |
794 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.08 |
[0.97, 1.20] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
10.3 Opioid combined spinal- |
1 |
34 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.45 |
[0.70, 2.98] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
11 Nausea/vomiting |
5 |
372 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.12 |
[0.67, 1.87] |
11.1 Combined spinal- |
3 |
261 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.92 |
[0.48, 1.77] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
11.2 Opioid combined spinal- |
1 |
69 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.97 |
[0.38, 2.48] |
epidural versus test local |
|
|
|
|
|
anaesthetic/opioid epidural |
|
|
|
|
|
11.3 Opioid combined spinal- |
1 |
42 |
Risk Ratio (M-H, Fixed, 95% CI) |
9.86 |
[0.56, 172.33] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
12 Hypotension |
10 |
1014 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.23 |
[0.88, 1.70] |
12.1 Combined spinal- |
8 |
715 |
Risk Ratio (M-H, Fixed, 95% CI) |
2.25 |
[1.02, 4.96] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
12.2 Opioid combined spinal- |
1 |
69 |
Risk Ratio (M-H, Fixed, 95% CI) |
Not estimable |
|
epidural versus test local |
|
|
|
|
|
anaesthetic/opioid epidural |
|
|
|
|
|
12.4 Null combined spinal- |
1 |
230 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.01 |
[0.71, 1.45] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
13 Respiratory depression |
5 |
375 |
Risk Ratio (M-H, Fixed, 95% CI) |
Not estimable |
|
13.1 Combined spinal- |
3 |
264 |
Risk Ratio (M-H, Fixed, 95% CI) |
Not estimable |
|
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
13.2 Opioid combined spinal- |
1 |
69 |
Risk Ratio (M-H, Fixed, 95% CI) |
Not estimable |
|
epidural versus test local |
|
|
|
|
|
anaesthetic/opioid epidural |
|
|
|
|
|
13.5 Opioid combined spinal- |
1 |
42 |
Risk Ratio (M-H, Fixed, 95% CI) |
Not estimable |
|
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
14 Headache (any) |
1 |
110 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.14 |
[0.01, 2.70] |
14.1 Combined spinal- |
1 |
110 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.14 |
[0.01, 2.70] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
15 Sedation |
0 |
0 |
Risk Ratio (M-H, Fixed, 95% CI) |
Not estimable |
|
16 Labour augmentation required |
6 |
1285 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.00 |
[0.88, 1.13] |
16.1 Combined spinal- |
3 |
944 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.95 |
[0.80, 1.13] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
16.2 Opioid combined spinal- |
1 |
69 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.55 |
[0.56, 4.28] |
epidural versus test local |
|
|
|
|
|
anaesthetic/opioid epidural |
|
|
|
|
|
16.3 Opioid combined spinal- |
1 |
42 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.55 |
[0.05, 5.61] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
|
|
|
|||
Combined spinal-epidural versus epidural analgesia in labour (Review) |
|
40 |
|||
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
16.4 Null combined spinal- |
1 |
230 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.07 |
[0.92, 1.24] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
17 Augmentation after analgesia |
0 |
0 |
Risk Ratio (M-H, Fixed, 95% CI) |
Not estimable |
|
18 Normal delivery |
11 |
1632 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.98 |
[0.91, 1.06] |
18.1 Combined spinal- |
8 |
1291 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.00 |
[0.91, 1.09] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
18.2 Opioid combined spinal- |
1 |
69 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.97 |
[0.77, 1.22] |
epidural versus test local |
|
|
|
|
|
anaesthetic/opioid epidural |
|
|
|
|
|
18.3 Opioid combined spinal- |
1 |
42 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.98 |
[0.73, 1.31] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
18.4 Null combined spinal- |
1 |
230 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.94 |
[0.83, 1.08] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
19 Instrumental delivery |
10 |
1572 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.07 |
[0.88, 1.30] |
19.1 Combined spinal- |
7 |
1231 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.06 |
[0.87, 1.30] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
19.2 Opioid combined spinal- |
1 |
69 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.97 |
[0.14, 6.51] |
epidural versus test local |
|
|
|
|
|
anaesthetic/opioid epidural |
|
|
|
|
|
19.3 Opioid combined spinal- |
1 |
42 |
Risk Ratio (M-H, Fixed, 95% CI) |
Not estimable |
|
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
19.4 Null combined spinal- |
1 |
230 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.28 |
[0.54, 3.03] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
20 Caesarean section |
10 |
1572 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.99 |
[0.82, 1.20] |
20.1 Combined spinal- |
7 |
1231 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.96 |
[0.78, 1.18] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
20.2 Opioid combined spinal- |
1 |
69 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.21 |
[0.36, 4.14] |
epidural versus test local |
|
|
|
|
|
anaesthetic/opioid epidural |
|
|
|
|
|
20.3 Opioid combined spinal- |
1 |
42 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.1 [0.32, 3.83] |
|
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
20.4 Null combined spinal- |
1 |
230 |
Risk Ratio (M-H, Fixed, 95% CI) |
1.24 |
[0.61, 2.52] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
21 Umbilical arterial pH |
4 |
306 |
Mean Difference (IV, Fixed, 95% CI) |
-0.02 [-0.02, -0.02] |
|
21.1 Combined spinal- |
3 |
264 |
Mean Difference (IV, Fixed, 95% CI) |
-0.02 [-0.02, -0.02] |
|
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
21.3 Opioid combined spinal- |
1 |
42 |
Mean Difference (IV, Fixed, 95% CI) |
0.04 |
[-0.03, 0.11] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
22 Umbilical venous pH |
2 |
85 |
Mean Difference (IV, Fixed, 95% CI) |
Not estimable |
|
|
|
|
|||
Combined spinal-epidural versus epidural analgesia in labour (Review) |
|
41 |
|||
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
22.1 Combined spinal- |
1 |
43 |
Mean Difference (IV, Fixed, 95% CI) |
0.02 |
[-0.04, 0.08] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
22.3 Opioid combined spinal- |
1 |
42 |
Mean Difference (IV, Fixed, 95% CI) |
0.04 |
[-0.00, 0.08] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
23 Umbilical cord pH |
1 |
110 |
Mean Difference (IV, Fixed, 95% CI) |
-0.02 [-0.05, 0.01] |
|
23.1 Combined spinal- |
1 |
110 |
Mean Difference (IV, Fixed, 95% CI) |
-0.02 [-0.05, 0.01] |
|
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
24 Apgar score < 7 at 5 minutes |
4 |
954 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.61 |
[0.26, 1.46] |
24.1 Combined spinal- |
4 |
954 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.61 |
[0.26, 1.46] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
25 Apgar score < 8 at 5 minutes |
5 |
979 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.91 |
[0.39, 2.12] |
25.1 Combined spinal- |
4 |
937 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.80 |
[0.33, 1.97] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
25.3 Opioid combined spinal- |
1 |
42 |
Risk Ratio (M-H, Fixed, 95% CI) |
3.29 |
[0.14, 76.33] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
26 Number admitted to neonatal |
3 |
852 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.77 |
[0.34, 1.73] |
unit |
|
|
|
|
|
26.1 Combined spinal- |
3 |
852 |
Risk Ratio (M-H, Fixed, 95% CI) |
0.77 |
[0.34, 1.73] |
epidural versus low-dose |
|
|
|
|
|
epidural |
|
|
|
|
|
Analysis 1.1. Comparison 1 Combined spinal-epidural versus traditional epidural, Outcome 1 Time from first injection to effective analgesia (minutes).
Review: Combined spinal-epidural versus epidural analgesia in labour
Comparison: 1 Combined spinal-epidural versus traditional epidural
Outcome: 1 Time from first injection to effective analgesia (minutes)
Study or subgroup |
CSE |
|
Epidural |
|
Mean Difference |
Weight |
Mean Difference |
|
N |
Mean(SD) |
N |
Mean(SD) |
IV,Fixed,95% CI |
|
IV,Fixed,95% CI |
2 Opioid combined spinal-epidural versus traditional epidural |
|
|
|
|
|
|
|||
Roux 1999 |
39 |
8 (11) |
40 |
12 (7) |
|
|
|
100.0 % |
-4.00 [ -8.08, 0.08 ] |
Total (95% CI) |
39 |
|
40 |
|
|
|
|
100.0 % |
-4.00 [ -8.08, 0.08 ] |
Heterogeneity: not applicable |
|
|
|
|
|
|
|
|
|
Test for overall effect: Z = 1.92 (P = 0.055) |
|
|
|
|
|
|
|
||
|
|
|
|
-10 |
-5 |
0 |
5 |
10 |
|
|
|
|
|
Favours CSE |
|
Favours epidural |
|
||
Combined spinal-epidural versus epidural analgesia in labour (Review) |
42 |
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 1.3. Comparison 1 Combined spinal-epidural versus traditional epidural, Outcome 3 Need for rescue analgesia.
Review: Combined spinal-epidural versus epidural analgesia in labour
Comparison: 1 Combined spinal-epidural versus traditional epidural
Outcome: 3 Need for rescue analgesia
Study or subgroup |
CSE |
Epidural |
|
|
|
|
Risk Ratio |
|
Weight |
Risk Ratio |
|
|
n/N |
n/N |
|
|
M-H,Fixed,95% CI |
|
M-H,Fixed,95% CI |
||||
|
|
|
|
|
|
|
|
|
|
||
1 Combined spinal-epidural versus traditional epidural |
|
|
|
|
|
|
|
|
|
||
Gomez 2001 |
5/21 |
16/21 |
|
|
|
|
|
|
|
100.0 % |
0.31 [ 0.14, 0.70 ] |
|
|
|
|
|
|
|
|||||
|
|
|
|
|
|
|
|||||
Total (95% CI) |
21 |
21 |
|
|
|
|
|
|
|
100.0 % |
0.31 [ 0.14, 0.70 ] |
Total events: 5 (CSE), 16 (Epidural) |
|
|
|
|
|
|
|
|
|
|
|
Heterogeneity: not applicable |
|
|
|
|
|
|
|
|
|
|
|
Test for overall effect: Z = 2.84 (P = 0.0045) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
0.1 |
0.2 |
0.5 |
1 |
2 |
5 |
10 |
|
||
|
|
|
Favours CSE |
|
Favours epidural |
|
|||||
Analysis 1.6. Comparison 1 Combined spinal-epidural versus traditional epidural, Outcome 6 Post dural puncture headache.
Review: Combined spinal-epidural versus epidural analgesia in labour
Comparison: 1 Combined spinal-epidural versus traditional epidural
Outcome: 6 Post dural puncture headache
Study or subgroup |
CSE |
Epidural |
|
|
Risk Ratio |
|
Risk Ratio |
||||
|
n/N |
n/N |
M-H,Fixed,95% CI |
|
M-H,Fixed,95% CI |
||||||
|
|
|
|
|
|
|
|
|
|
|
|
2 Opioid combined spinal-epidural versus traditional epidural |
|
|
|
|
|
|
|
|
|
|
|
Caldwell 1994 |
1/26 |
0/33 |
|
|
|
|
|
|
|
|
3.78 [ 0.16, 89.09 ] |
|
|
|
|
|
|
|
|
||||
|
|
|
|
|
|
|
|
||||
|
|
|
|
|
|
|
|||||
Roux 1999 |
0/39 |
0/40 |
|
|
|
|
|
|
|
0.0 [ 0.0, 0.0 ] |
|
Total (95% CI) |
65 |
73 |
|
|
|
|
|
|
|
3.78 [ 0.16, 89.09 ] |
|
Total events: 1 (CSE), 0 (Epidural) |
|
|
|
|
|
|
|
|
|
|
|
Heterogeneity: Chi2 = 0.0, df = 0 (P = 1.00); I2 =0.0% |
|
|
|
|
|
|
|
|
|
|
|
Test for overall effect: Z = 0.82 (P = 0.41) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.01 |
0.1 |
|
1 |
10 |
100 |
|||
|
|
|
Favours CSE |
|
|
Favours epidural |
|||||
|
|
|
|
|
|
|
|
|
|
|
|
Combined spinal-epidural versus epidural analgesia in labour (Review) |
|
43 |
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & |
Sons, Ltd. |
|
|
|
|
Analysis 1.7. Comparison 1 Combined spinal-epidural versus traditional epidural, Outcome 7 Known dural tap.
Review: Combined spinal-epidural versus epidural analgesia in labour
Comparison: 1 Combined spinal-epidural versus traditional epidural
Outcome: 7 Known dural tap
Study or subgroup |
CSE |
Epidural |
|
Risk Ratio |
Weight |
Risk Ratio |
||
|
n/N |
n/N |
M-H,Fixed,95% CI |
|
M-H,Fixed,95% CI |
|||
1 Combined spinal-epidural versus traditional epidural |
|
|
|
|
|
|
|
|
COMET 2001a |
0/351 |
1/353 |
|
|
|
|
61.5 % |
0.34 [ 0.01, 8.20 ] |
Subtotal (95% CI) |
351 |
353 |
|
|
|
|
61.5 % |
0.34 [ 0.01, 8.20 ] |
Total events: 0 (CSE), 1 (Epidural) |
|
|
|
|
|
|
|
|
Heterogeneity: not applicable |
|
|
|
|
|
|
|
|
Test for overall effect: Z = 0.67 (P = 0.50) |
|
|
|
|
|
|
|
|
2 Opioid combined spinal-epidural versus traditional epidural |
|
|
|
|
|
|
||
Caldwell 1994 |
1/26 |
0/33 |
|
|
|
|
18.2 % |
3.78 [ 0.16, 89.09 ] |
Roux 1999 |
4/39 |
0/40 |
|
|
|
|
20.3 % |
9.23 [ 0.51, 165.84 ] |
Subtotal (95% CI) |
65 |
73 |
|
|
|
|
38.5 % |
6.65 [ 0.80, 55.31 ] |
Total events: 5 (CSE), 0 (Epidural) |
|
|
|
|
|
|
|
|
Heterogeneity: Chi2 = 0.17, df = 1 (P = 0.68); I2 =0.0% |
|
|
|
|
|
|
||
Test for overall effect: Z = 1.75 (P = 0.080) |
|
|
|
|
|
|
|
|
Total (95% CI) |
416 |
426 |
|
|
|
|
100.0 % |
2.77 [ 0.66, 11.65 ] |
Total events: 5 (CSE), 1 (Epidural) |
|
|
|
|
|
|
|
|
Heterogeneity: Chi2 = 2.38, df = 2 (P = 0.30); I2 =16% |
|
|
|
|
|
|
||
Test for overall effect: Z = 1.39 (P = 0.17) |
|
|
|
|
|
|
|
|
|
|
0.001 0.01 |
0.1 |
1 |
10 |
100 |
1000 |
|
|
|
Favours CSE |
|
Favours epidural |
|
|||
Combined spinal-epidural versus epidural analgesia in labour (Review) |
44 |
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Analysis 1.8. Comparison 1 Combined spinal-epidural versus traditional epidural, Outcome 8 Number of women requiring blood patch for post dural puncture headache.
Review: Combined spinal-epidural versus epidural analgesia in labour
Comparison: 1 Combined spinal-epidural versus traditional epidural
Outcome: 8 Number of women requiring blood patch for post dural puncture headache
Study or subgroup |
Treatment |
Control |
|
|
Risk Ratio |
|
Risk Ratio |
|
|
n/N |
n/N |
|
M-H,Fixed,95% CI |
M-H,Fixed,95% CI |
|||
|
|
|
|
|
|
|
|
|
2 Opioid combined spinal-epidural versus traditional epidural |
|
|
|
|
|
|
|
|
Roux 1999 |
0/39 |
0/40 |
|
|
|
|
|
0.0 [ 0.0, 0.0 ] |
Total (95% CI) |
39 |
40 |
|
|
|
|
|
0.0 [ 0.0, 0.0 ] |
Total events: 0 (Treatment), 0 (Control) |
|
|
|
|
|
|
|
|
Heterogeneity: not applicable |
|
|
|
|
|
|
|
|
Test for overall effect: Z = 0.0 (P < 0.00001) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.1 |
0.2 |
0.5 |
1 |
2 |
5 |
10 |
|
|
|
Favours CSE |
|
Favours epidural |
|||
Analysis 1.9. Comparison 1 Combined spinal-epidural versus traditional epidural, Outcome 9 Pruritus.
Review: Combined spinal-epidural versus epidural analgesia in labour
Comparison: 1 Combined spinal-epidural versus traditional epidural
Outcome: 9 Pruritus
Study or subgroup |
CSE |
Epidural |
|
Risk Ratio |
Risk Ratio |
||||
|
n/N |
n/N |
M-H,Fixed,95% CI |
M-H,Fixed,95% CI |
|||||
|
|
|
|
|
|
|
|
|
|
1 Combined spinal-epidural versus traditional epidural |
|
|
|
|
|
|
|
|
|
Gomez 2001 |
11/21 |
2/21 |
|
|
|
|
|
|
5.50 [ 1.38, 21.86 ] |
|
|
|
|
|
|
||||
|
|
|
|
|
|
||||
|
|
|
|
|
|
||||
Tsen 1999 |
0/50 |
0/50 |
|
|
|
|
|
|
0.0 [ 0.0, 0.0 ] |
Subtotal (95% CI) |
71 |
71 |
|
|
|
|
|
|
5.50 [ 1.38, 21.86 ] |
Total events: 11 (CSE), 2 (Epidural) |
|
|
|
|
|
|
|
|
|
Heterogeneity: Chi2 = 0.0, df = 0 (P = 1.00); I2 =0.0% |
|
|
|
|
|
|
|
|
|
Test for overall effect: Z = 2.42 (P = 0.015) |
|
|
|
|
|
|
|
|
|
2 Opioid combined spinal-epidural versus traditional epidural |
|
|
|
|
|
|
|
|
|
Caldwell 1994 |
13/26 |
1/33 |
|
|
|
|
|
|
16.50 [ 2.31, 118.07 ] |
|
|
|
|
|
|
||||
Roux 1999 |
39/39 |
35/40 |
|
|
|
|
|
|
1.14 [ 1.01, 1.29 ] |
|
|
|
|
|
|
||||
Subtotal (95% CI) |
65 |
73 |
|
|
|
|
|
|
1.52 [ 1.25, 1.84 ] |
|
|
|
|
|
|
|
|
|
|
|
|
0.001 0.01 |
0.1 |
1 |
|
10 |
100 |
1000 |
|
|
|
Favours CSE |
|
|
Favours epidural |
||||
|
|
|
|
|
|
|
|
|
(Continued . . . ) |
|
|
|
|
|
|
|
|
||
Combined spinal-epidural versus epidural analgesia in labour (Review) |
|
|
|
|
|
|
45 |
||
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
|
|
|
|
|
|
|
(. . . Continued) |
Study or subgroup |
CSE |
Epidural |
|
Risk Ratio |
Risk Ratio |
||
|
n/N |
n/N |
M-H,Fixed,95% CI |
M-H,Fixed,95% CI |
|||
|
|
|
|
|
|
|
|
Total events: 52 (CSE), 36 (Epidural) |
|
|
|
|
|
|
|
Heterogeneity: Chi2 = 25.53, df = 1 (P<0.00001); I2 =96% |
|
|
|
|
|
|
|
Test for overall effect: Z = 4.27 (P = 0.000019) |
|
|
|
|
|
|
|
Total (95% CI) |
136 |
144 |
|
|
|
|
1.73 [ 1.39, 2.14 ] |
Total events: 63 (CSE), 38 (Epidural) |
|
|
|
|
|
|
|
Heterogeneity: Chi2 = 49.81, df = 2 (P<0.00001); I2 =96% |
|
|
|
|
|
|
|
Test for overall effect: Z = 5.01 (P < 0.00001) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.001 0.01 |
0.1 |
1 |
10 |
100 |
1000 |
|
|
Favours CSE |
|
Favours epidural |
|||
Analysis 1.10. Comparison 1 Combined spinal-epidural versus traditional epidural, Outcome 10 Urinary retention.
Review: Combined spinal-epidural versus epidural analgesia in labour
Comparison: 1 Combined spinal-epidural versus traditional epidural
Outcome: 10 Urinary retention
Study or subgroup |
CSE |
Epidural |
|
Risk Ratio |
Weight |
Risk Ratio |
|
|
n/N |
n/N |
M-H,Fixed,95% CI |
|
M-H,Fixed,95% CI |
||
|
|
|
|
|
|
|
|
1 Combined spinal-epidural versus traditional epidural |
|
|
|
|
|
|
|
COMET 2001a |
244/351 |
282/353 |
|
|
|
100.0 % |
0.87 [ 0.80, 0.95 ] |
|
|
|
|||||
Total (95% CI) |
351 |
353 |
|
|
|
100.0 % |
0.87 [ 0.80, 0.95 ] |
Total events: 244 (CSE), 282 (Epidural)
Heterogeneity: not applicable
Test for overall effect: Z = 3.14 (P = 0.0017)
0.1 |
0.2 |
0.5 |
1 |
2 |
5 |
10 |
|
Favours CSE |
|
Favours epidural |
|||
Combined spinal-epidural versus epidural analgesia in labour (Review) |
46 |
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. |
|
|
|
Analysis 1.11. Comparison 1 Combined spinal-epidural versus traditional epidural, Outcome 11 Nausea/vomiting.
Review: Combined spinal-epidural versus epidural analgesia in labour
Comparison: 1 Combined spinal-epidural versus traditional epidural
Outcome: 11 Nausea/vomiting
Study or subgroup |
CSE |
Epidural |
|
|
|
Risk Ratio |
Risk Ratio |
||||||||
|
n/N |
n/N |
M-H,Random,95% CI |
M-H,Random,95% CI |
|||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1 Combined spinal-epidural versus traditional epidural |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gomez 2001 |
1/21 |
4/21 |
|
|
|
|
|
|
|
|
|
|
|
|
0.25 [ 0.03, 2.05 ] |
|
|
|
|
|
|
|
|
|
|
|
|
||||
Tsen 1999 |
0/50 |
0/50 |
|
|
|
|
|
|
|
|
|
|
|
|
0.0 [ 0.0, 0.0 ] |
Subtotal (95% CI) |
71 |
71 |
|
|
|
|
|
|
|
|
|
|
|
|
0.25 [ 0.03, 2.05 ] |
Total events: 1 (CSE), 4 (Epidural) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Heterogeneity: Tau2 = 0.0; Chi2 = 0.0, df = 0 (P = 1.00); I2 =0.0% |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Test for overall effect: Z = 1.29 (P = 0.20) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2 Opioid combined spinal-epidural versus traditional epidural |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Caldwell 1994 |
13/26 |
5/33 |
|
|
|
|
|
|
|
|
|
|
|
|
3.30 [ 1.35, 8.07 ] |
|
|
|
|
|
|
|
|
|
|
|
|
||||
Roux 1999 |
14/39 |
13/40 |
|
|
|
|
|
|
|
|
|
|
|
|
1.10 [ 0.60, 2.04 ] |
|
|
|
|
|
|
|
|
|
|
|
|
||||
Subtotal (95% CI) |
65 |
73 |
|
|
|
|
|
|
|
|
|
|
|
|
1.82 [ 0.62, 5.33 ] |
Total events: 27 (CSE), 18 (Epidural) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Heterogeneity: Tau2 = 0.45; Chi2 = 3.97, df = 1 (P = 0.05); I2 =75% |
|
|
|
|
|
|
|
|
|
|
|
|
|
||
Test for overall effect: Z = 1.09 (P = 0.28) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Total (95% CI) |
136 |
144 |
|
|
|
|
|
|
|
|
|
|
|
|
1.29 [ 0.44, 3.83 ] |
Total events: 28 (CSE), 22 (Epidural) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Heterogeneity: Tau2 = 0.60; Chi2 = 6.68, df = 2 (P = 0.04); I2 =70% |
|
|
|
|
|
|
|
|
|
|
|
|
|
||
Test for overall effect: Z = 0.46 (P = 0.64) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
0.01 |
0.1 |
|
|
1 |
|
|
10 |
100 |
|||||
|
|
Favours CSE |
|
|
|
|
|
|
Favours epidural |
||||||
Combined spinal-epidural versus epidural analgesia in labour (Review) |
47 |
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. |
|
|
|