Patient-controlled epidural analgesia in labor does not always improve maternal satisfaction

Abstract

Background . We investigated whether patient-controlled epidural analgesia in labor with bupivacaine and fentanyl provides more satisfaction to mothers than intermittent bolus epidural analgesia or patient-controlled epidural analgesia with plain bupivacaine. Methods . Ninety mothers with term, uncomplicated pregnancies were randomized to receive intermittent bolus epidural analgesia (bupivacaine?+?fentanyl), patient-controlled epidural analgesia (bupivacaine?+?fentanyl), or patient-controlled epidural analgesia (bupivacaine). Pain during labor was evaluated with a visual analog scale. Obstetric and neonatal outcomes were recorded. After delivery, the mothers were given a questionnaire covering the following themes: experience of labor pain, feeling of control, fears and expectations associated with pregnancy/with delivery/with becoming a mother, as well as pain, physical condition and emotions after delivery. To elaborate on these answers, 30 mothers were further randomized to a semistructured interview, in which the same topics were discussed. The main outcome measure was maternal satisfaction. Results . The intermittent bolus epidural analgesia group felt they could influence labor most ( p =0.03), and in the interview they expressed most satisfaction. In this group, the total drug utilization was smallest (bupivacaine: p <0.0001 comparing all groups, fentanyl: p =0.03 comparing the two fentanyl-receiving groups). No differences in pain occurred. Vomiting (p =0.04) and pruritus (p <0.0001) were more common or more severe in the groups receiving fentanyl. Conclusions. We found no advantages for patient-controlled epidural analgesia over intermittent bolus epidural analgesia in terms of maternal satisfaction. © 2006 Taylor & Francis.