title: Patient-controlled epidural technique improves analgesia for labor but increases cesarean delivery rate compared with the intermittent bolus technique.
abstract: BACKGROUND
  We tested the hypothesis that patient-controlled epidural analgesia for labor (PCEA) provides better analgesia and satisfaction than the intermittent bolus technique (bolus) without affecting the mode of delivery.
  
  
  METHODS
  We randomized 187 parturients to receive labor analgesia using either the PCEA or bolus technique. The PCEA group received a starting bolus of 14 mg of bupivacaine and 60 micro g of fentanyl in a 15-ml volume, followed by a background infusion (bupivacaine 0.08% and fentanyl 2 microg ml(-1)) 5 ml h(-1) with a 5-ml bolus and 15-min lock-out interval. The bolus group received boluses of 20 mg of bupivacaine and 75 micro g of fentanyl in a 15-ml volume.
  
  
  RESULTS
  Parturients in the PCEA group had significantly (P < 0.05-0.01) less pain during the first and second stages of labor. There was no difference in the spontaneous delivery rate between the groups, but the cesarean delivery rate was significantly (P < 0.05) higher (16.3% vs. 6.7%) in the PCEA group than in the bolus group. Bupivacaine consumption was significantly (P < 0.01) higher (11.2 mg h(-1) vs. 9.6 mg h(-1)) and the second stage of labor was significantly (P < 0.01) longer (70 min vs. 54 min) in the PCEA group than in the bolus group. Patient satisfaction was equally good in both groups.
  
  
  CONCLUSIONS
  The PCEA technique provided better pain relief. This was associated with higher bupivacaine consumption, prolongation of the second stage of labor, and an increased rate of cesarean section.
authors.affiliation: Department of Anesthesia and Intensive Care, Helsinki University Central Hospital, Helsinki, Finland. pekka.halonen@hus.fi
authors.forename: P
authors.initials: P
authors.lastname: Halonen
authors.forename: J
authors.initials: J
authors.lastname: Sarvela
authors.forename: T
authors.initials: T
authors.lastname: Saisto
authors.forename: A
authors.initials: A
authors.lastname: Soikkeli
authors.forename: E
authors.initials: E
authors.lastname: Halmesmäki
authors.forename: K
authors.initials: K
authors.lastname: Korttila
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D002585:Cesarean Section / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007743:Labor, Obstetric / Q000187:drug effects*; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011247:Pregnancy; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine