Background and aims Evaluate the advantages and drawbacks of CSA in trial for labour using a 23-gauge over the needle spinal catheter

Methods After an ethics committee evaluation and written informed consent, 104 ASA 1 and 2 parturients (obesity diabetes pre-eclampsia previous C-section twin pregnancy) scheduled for labour trial were included in the study. Age of the patients ranged from 17 to 42, with a mean of 25 years.

When regular contractions and minimum 2–3 cm cervical dilatation, a 23-gauge flexible cannula over a 27-gauge pencil-point spinal needle was introduced into the subarachnoid space through a peel-away Tuohy introducer. the puncture was performed at the L2-L3 interspace with the patient in the lateral decubitus and without loading. First bolus intrathecally 3 mg Ropivacaine and 2,5 µg Sufentanil total volume 2 ml. Manual boluses of 2 ml: Ropivacaine 3 mg +Sufentanil 2,5µg or Saline (0.5 ml) were administered on demand (on average every 60 minutes).

Results Onset of analgesia was 5 up to 10 minutes, at any dilatation. Mean consumption of Ropivacaine was 2,7 mg and Sufentanyl 1,8µg hourly for a mean duration of labour of 6 hours; 1 for up to 16 hours. 79 parturients delivered spontaneously, 14 with total comfort for operative vaginal and 11 with successful immediate conversion to C-section. No motor block; perfect hemodynamic stability. 25 patients (24%) experienced transient paresthesia and 3 (4,8%) transient migraine. In 3 cases (2,8%) PDPH identified early after delivery required blood patch.

Conclusions CSA with Wiley Spinal is a safe and efficient technique.