To CSE or not to CSE? - UW Anesthesiology & Pain Medicine

The level of pain experienced during labor is different for every person. It’s important to work with your gynecologist and obstetric anesthesiologist to decide what pain management methods work best for you. Last year, Dr. Carlos Delgado, Associate Professor of Obstetric Anesthesia in the UW Department of Anesthesiology & Pain Medicine, was invited on the podcast ‘Partum the Interruption’ to discuss the use of different neuraxial techniques such as spinal, epidural, and combined spinal-epidural (CSE) to achieve a reliable, fast, and durable block for pain during labor.

The host of the podcast, Dr. M, who is a board-certified obstetric anesthesiologist, and Dr. Delgado talked about various ways to optimize epidural function in a patient undergoing a trial of labor following previous cesarean delivery and who has a history of both obesity and difficult spinal placement.

Dr. Delgado explained that the straight epidural, dural puncture epidural (DPE) and combined spinal epidural (CSE) are all valid options to provide pain relief during labor. In a dural puncture technique (DPE or CSE), obtaining cerebrospinal fluid (CSF) guarantees the catheter is in the right space – the epidural space – and that it is midline, which reduces the likelihood of unilateral or failed blocks.

Epidural catheters are used to provide surgical anesthesia if a cesarean delivery is needed. The anesthesiologists can tell how well a catheter is working throughout labor by doing frequent assessments and keeping track of the number of extra boluses (top-ups) of medication that need to be administered. A poorly working catheter during labor may not work for cesarean, which can lead to experiencing pain during the surgical procedure or needing to convert to general anesthesia. A catheter of higher reliability is placed after a DPE or CSE technique in all patients, especially those with high body mass index (BMI). The patients who go with dural puncture epidural (DPE) technique face less catheter failures and higher satisfaction.

Listen to the full podcast on Spotify.