{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:18:10Z","timestamp":1783491490113,"version":"3.55.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neuraxial analgesia is the most effective method for labor pain relief. Continuous epidural analgesia (CEA) provides reliable analgesia but is associated with delayed onset, while traditional combined spinal\u2013epidural analgesia (CSE) offers rapid pain relief at the expense of increased maternal side effects. Modified CSE techniques, typically involving reduced intrathecal drug doses and\/or optimized epidural maintenance strategies have been introduced to balance rapid onset with improved safety, but comparative real-world evidence remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this multicenter retrospective cohort study, 120 term parturients received labor analgesia with continuous epidural analgesia (CEA,\n                      <jats:italic>n<\/jats:italic>\n                      = 40), traditional combined spinal\u2013epidural analgesia (CSE,\n                      <jats:italic>n<\/jats:italic>\n                      = 40), or modified CSE (\n                      <jats:italic>n<\/jats:italic>\n                      = 40) at three tertiary hospitals. All intrathecal administrations of bupivacaine were hyperbaric. The primary outcomes were early analgesic efficacy, including time to effective analgesia [visual analog scale (VAS) \u2264 3] and VAS scores within the first 60 min. Secondary outcomes included inadequate analgesia at 1 h (VAS &amp;gt; 4), maternal hemodynamic effects, motor block, labor and delivery outcomes, neonatal outcomes, and maternal satisfaction\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median onset of effective analgesia was significantly shorter with traditional CSE (median difference vs. CEA:-12 min) and modified CSE (median difference vs. CEA:-9 min) compared with CEA (18 min;\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Inadequate analgesia at 1 h occurred more frequently with CEA (18.1%) than with traditional CSE (4.2%) or modified CSE (6.7%) (absolute risk reduction 11.4% compared with modified CSE). Rescue analgesic interventions during the first hour after neuraxial initiation were comparable across groups (CEA 6.7%, traditional CSE 6.7%, modified CSE 8.3%). Traditional CSE was associated with higher rates of hypotension and motor block, whereas modified CSE demonstrated a safety profile comparable to CEA. Maternal hemodynamic stability, labor duration, delivery mode, and neonatal outcomes were similar among the three groups. However, the study was underpowered to detect differences in rare maternal or neonatal adverse events, and these findings should be interpreted cautiously. Maternal satisfaction was highest in the modified CSE group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Modified CSE provides faster early analgesia than CEA and is associated with fewer episodes of pain exceeding a VAS score of 4 a while requiring similar rates of rescue analgesic interventions as CEA and traditional CSE, and maintaining better hemodynamic stability and less motor block than traditional CSE. All intrathecal bupivacaine doses were hyperbaric. Other maternal and neonatal outcomes should be interpreted cautiously due to limited power for rare events. Overall, the results support modified CSE as a pragmatic refinement of neuraxial labor analgesia in routine clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1805555","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:53:58Z","timestamp":1783490038000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of continuous epidural analgesia, traditional combined spinal\u2013epidural, and modified combined spinal\u2013epidural for labor analgesia: a multicenter retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Xianghuan","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Operation, Cangnan Hospital of Wenzhou Medical University (The People\u2019s Hospital of Cangnan)","place":["Zhejiang, 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongliang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Ruian People\u2019s Hospital (The Third Affiliated Hospital of Wenzhou Medical University)","place":["Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"CD000331","DOI":"10.1002\/14651858.CD000331.pub4","article-title":"Epidural versus non-epidural or no analgesia for pain management in labour.","volume":"5","author":"Anim-Somuah","year":"2018","journal-title":"Cochrane Database Syst Rev."},{"key":"B2","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s44158-025-00224-3","article-title":"Technical aspects of neuraxial analgesia during labor and maternity care: an updated overview.","volume":"5","author":"Coviello","year":"2025","journal-title":"J 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