title: Comparison of continuous background infusion plus demand dose and demand-only parturient-controlled epidural analgesia (PCEA) using ropivacaine combined with sufentanil for labor and delivery.
abstract: BACKGROUND
  Using ropivacaine combined with sufentanil, we determined the analgesic efficacy of parturient-controlled epidural analgesia (PCEA) with or without (demand-only PCEA) continuous background infusion in reducing labor pain in 66 parturients.
  
  
  METHODS
  After placement of the epidural catheter and administration of an initial bolus containing ropivacaine 16 mg and sufentanil 10 microg, parturients were prospectively randomized into two groups. The PCEA solution consisted of ropivacaine 0.16% plus sufentanil 0.5 microg/mL. Parturients with PCEA plus continuous background infusion received 4 mL/h plus an hourly maximum of three 4-mL boluses on demand (lock-out time 20 min); parturients with demand-only PCEA received an hourly maximum of four 4-mL boluses (lock-out time 15 min) of anesthetic solution. Pain scores (VAS 0-100 mm), drug doses administered, duration of labor, sensory and motor epidural block characteristics, maternal satisfaction, neonatal outcome and adverse events were determined.
  
  
  RESULTS
  Both regimens provided excellent parturients' satisfaction and pain relief. However, periods of VAS scores>40 mm during all stages of labor were significantly more frequent in parturients receiving demand-only PCEA (22.4%) compared to parturients receiving PCEA plus continuous background infusion (7.5%, P=0.0011). Drug doses administered, duration of PCEA, labor and delivery, epidural block characteristics, neonatal outcome and adverse events did not differ between groups.
  
  
  CONCLUSIONS
  Under the conditions of the study, PCEA plus continuous background infusion was more effective than demand-only PCEA in treating labor pain without increasing consumption of anesthetic solution.
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany. Bremerich@em.uni-frankfurt.de
authors.forename: D H
authors.initials: DH
authors.lastname: Bremerich
authors.forename: H J
authors.initials: HJ
authors.lastname: Waibel
authors.forename: S
authors.initials: S
authors.lastname: Mierdl
authors.forename: D
authors.initials: D
authors.lastname: Meininger
authors.forename: C
authors.initials: C
authors.lastname: Byhahn
authors.forename: B C
authors.initials: BC
authors.lastname: Zwissler
authors.forename: H H
authors.initials: HH
authors.lastname: Ackermann
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D048949:Labor Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine; D017409:Sufentanil / Q000008:administration & dosage*
chemical_list: D000577:Amides; D000077212:Ropivacaine; D017409:Sufentanil