Comparison of intermittent epidural bolus, continuous epidural infusion and patient controlled-epidural analgesia during labor.
The aim of the study was to compare efficacy and side-effects produced by three techniques of epidural analgesia during labor: intermittent bolus (1B), continuous epidural infusion (CEI) and patient-controlled epidural analgesia (PCEA). One hundred and fifty parturients allocated randomly to three groups received the same epidural solution of bupivacaine 0.125% with sufentanil 0.5 microg/mL. In the first group (IB: n=50) boluses were administered by the anesthesiologist and titrated to achieve adequate analgesia. In the second group (CEI: n=50) an 8 mL/h continuous infusion was delivered. In the third group (PCEA: n=50) parturients self-administered 5 mL boluses, with a lock-out interval of 10 min and a 4 h maximum dose of 50 mL. Insufficient analgesia in the CEI and PCEA groups was treated by extra boluses of the same solution. Quality of analgesia measured by visual analog scale (VAS), and maternal satisfaction were comparable in the three groups. Hourly consumption of bupivacaine was lower in the 113 group compared to the PCEA and CEI groups (p<0.05). The number of extra boluses was significantly higher in the CEI group compared to the PCEA group (32% vs. 12.5%). Motor block was significantly more frequent in the CEI group compared to the 113 group. The other side-effects were equally distributed in the three groups. We concluded that PCEA with bupivacaine and sufentanil is a valuable technique and a good alternative to the IB method. Compared to the CEI technique, PCEA allows a decrease in local anesthetic consumption without impairing the quality of anesthesia.
Department of Anesthesia and Intensive Care, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun Créteil, France.
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Boutros
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Blary
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Bronchard
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Bonnet