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Complications of Combined Spinal-Epidural Technique for Labor: Analgesia--Complicating the Informed Consent Process?

Heyman, Harold J. MD

Letter to the Editor

Department of Anesthesiology, Illinois Masonic Medical Center, Chicago, IL 60657-5193.

To the Editor:

Norris et al. [1] recently compared the complications of continuous epidural analgesia (CLE) for labor with those of the combined spinal epidural (CSE) technique. The usual list of complications of CLE [2], such as maternal hypotension, accidental dural puncture, intravascular injection of local anesthetic, and high sensorimotor neural blockade, is now being supplemented with an additional list of possible complications attributed to the use of intrathecal opioids in the CSE technique. This new list includes [1] itching, nausea, vomiting, acute respiratory depression, "high spinal," sedation, euphoria, and slurred speech. Although informed consent for CLE given to the parturient has been shown to be feasible [3], obtaining a proper informed consent for a technique (CSE), which demonstrates some new, possibly significant risks, might influence some parturients to elect of different analgesic technique.

We asked Dr. Norris for a response but failed to obtain one.

Harold J. Heyman, MD

Department of Anesthesiology, Illinois Masonic Medical Center, Chicago, IL 60657-5193

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1. Norris MC, Grieco WM, Borkowski M, et al. Complications of labor analgesia: epidural versus combined spinal epidural techniques. Anesth Analg 1994;79:529-37.
2. Glosten B. Epidural and spinal anesthesia: local anesthetic techniques. In: Chestnut DH, ed. Obstetric anesthesia: principles and practice. St. Louis: Mosby, 1994;354-78.
3. Salvesen JC, Spielman FJ. Legal and ethical issues in obstetric anesthesia. In: Norris MC, ed. Obstetric anesthesia. Philadelphia: JB Lippincott, 1993;847-64.
© 1995 International Anesthesia Research Society