Comparison of continuous epidural analgesia, traditional combined spinal-epidural, and modified combined spinal-epidural for labor analgesia: a multicenter retrospective cohort study.

Background: 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-epidural 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. Methods: In this multicenter retrospective cohort study, 120 term parturients received labor analgesia with continuous epidural analgesia (CEA, Results: 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; Conclusion: 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.