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Combined Spinal-Epidural (C.S.E.)

This is a type of pain relief for women in labour. In some cases, anesthesiologists are able to offer combined spinal-epidural (also called a "walking epidural"). This is a modified form of epidural which gives you pain relief without numbness or weakness in your lower body. The technique is no more difficult than having a regular epidural.

An epidural needle is used to find the epidural space. Next, a thin spinal needle is passed inside the epidural needle into the fluid space around the nerves. A small dose of narcotic, with or without some freezing medication, is injected and the spinal needle is removed. An epidural catheter is passed into the epidural space and the epidural needle is removed, leaving the catheter in place. Pain relief occurs rapidly and does not impair mobility of the legs or your ability to push. The single dose lasts about 90 minutes. Therefore, we start giving a small amount of medication through the epidural catheter shortly after insertion. This is done with a slow infusion and can be supplemented with additional doses from the infusion pump that the patient controls (patient controlled epidural analgesia). This is continued until the baby is born.

The side effects that occur with this technique are the same as for an epidural. In addition, many patients experience itching of the skin. This is rarely severe and effective treatment is available. As with epidurals, there is a small risk (about 1 in 200) of developing a headache 12 to 48 hours after having CSE. Although this technique is used to avoid weakness and numbness in the legs, these may still occur but usually for no more than thirty minutes.

See also: epidural side effects and complications.

For more information about epidural analgesia for labour, please see the Division of Obstetrical Anesthesia.