"Ultra-light" patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload.
BACKGROUND
Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for maintenance of labor analgesia. Some of these benefits may depend on the PCEA settings. This study evaluated several regimens for "ultra-light" (0.125%) PCEA with basal continuous infusion (CI) in labor with goals of minimizing physician interventions while providing good analgesia.


METHODS
Two hundred and twenty ASA I-II women receiving epidural analgesia during active labor (cervical dilation <5 cm) were randomly assigned in a double-blind manner to four treatment groups (n=30 in each). Analgesia was maintained with a PCEA/CI pump using bupivacaine 0.0625% + sufentanil 0.35 microg/mL. PCEA settings were: group A: CI 10 mL/h, PCEA bolus 6 mL, 8-min lockout; group B: CI 10 mL/h, PCEA bolus 12 mL, 16-min lockout; group C: CI 15 mL/h, PCEA bolus 6 mL, 8-min lockout; group D: CI 15 mL/h, PCEA bolus 12 mL, 16-min lockout.


RESULTS
In groups A, B, C and D, 76, 77, 75 and 85% of parturients respectively, required no physician rescue boluses. Pain scores were low and maternal satisfaction was high in all groups, with minimal differences among them. Spontaneous vaginal delivery occurred in 78% of patients overall, instrumental (forceps or vacuum) delivery in 10% and cesarean section in 12%.


CONCLUSIONS
These ultra-light PCEA regimens provided excellent analgesia with minimal physician workload and a high spontaneous delivery rate. Use of moderate to high-volume, ultra-light PCEA/CI techniques should facilitate provision of labor analgesia in busy obstetric units.
Carvalho
B
B
Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA. bcarvalho@stanford.edu
Cohen
S E
SE
Giarrusso
K
K
Durbin
M
M
Riley
E T
ET
Lipman
S
S
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D001034:Apgar Score; D002045:Bupivacaine; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D010147:Pain Measurement / Q000187:drug effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D017409:Sufentanil; D016526:Workload
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D017409:Sufentanil; D002045:Bupivacaine