Patient-Controlled Epidural Analgesia during Labor and Delivery

Abstract

BACKGROUND: Epidural administration of dilute solution of local anesthetic and lipid‐soluble opioid provides the best pain relief during labor and delivery. The purpose of this study was to evaluate the safety, efficacy and patient satisfaction of patient‐controlled epidural analgesia compared with continuous infusion epidural analgesia. METHODS: Forty healthy full‐term parturients who requested epidural analgesia were assigned randomly to either patient‐controlled epidural analgesia (PCEA) group or continuous infusion epidural analgesia (CIEA) group. All parturients received proper dose of 0.25% bupivacaine with 0.0008% fentanyl to block T10 sensory level. PCEA was programmed as followings; no background infusion, a 4 ml bolus dose and 15min lock‐out interval using 0.0625% bupivacaine with 0.0002% fentanyl. CIEA was started with the same solution at 12ml/hr constantly. RESULTS: Hourly requirement of 0.0625% bupivacaine (mean+/‐SD 7.1+/‐5.8 ml/hr, median 7.6 ml/hr in PCEA group and mean+/‐SD 13.2+/‐2.9 ml/hr, median 12 ml/hr in CIEA group) during labor was significantly reduced in PCEA group (p<0.05). Maternal satisfaction, obstetric and neonatal parameters were shown no statistically significant difference. Incidences of postpartum complications such as gait disturbance, urinary difficulty, pruritus, nausea and vomiting were rare in both groups. CONCLUSIONS: Patient‐controlled epidural analgesia is safe and effective and has 37% sparing effect of bupivacaine dosage used per hour compared with continuous infusion epidural analgesia. [By kind permission, KoreaMed, Korean Association of Medical Journal Editors.]