title: Patient-controlled epidural analgesia during labor using ropivacaine and fentanyl provides better maternal satisfaction with less local anesthetic requirement.
abstract: OBJECTIVE
  To test the hypothesis that patient-controlled epidural analgesia (PCEA) using ropivacaine and fentanyl provides better maternal satisfaction and less anesthetic requirement than conventional continuous epidural infusion (CEI) during labor, we studied 58 uncomplicated parturients (singleton, vertex presentation).
  
  
  METHODS
  After establishing effective epidural analgesia with 11 ml of 0.2% ropivacaine, all parturients were randomly divided into one of two groups: the PCEA group (n = 29) or the CEI group (n = 29). In the PCEA group, the pump was initiated to deliver a basal infusion at 6 ml x h(-1) and a demand dose of 5 ml; the lockout interval was 10 min, and there was a 31 ml x h(-1) limit. The drugs used were 0.1% ropivacaine + fentanyl 2 microg x ml(-1). In the CEI group, epidural analgesia was maintained with the same solution as the PCEA group at a constant rate of 10 ml x h(-1). If parturients requested additional analgesia in the CEI group, we added 8 ml of epidural 0.2% ropivacaine without fentanyl.
  
  
  RESULTS
  Parturients' demographic data, such as duration of labor, mode of delivery, Apgar score, and umbilical arterial pH did not differ between the two groups. However, the hourly requirement of ropivacaine was significantly less in the PCEA group than in the CEI group (9.3 +/- 2.5 vs. 17.6 +/- 7.6 mg x h(-1); P < 0.05). Parturients' satisfaction assessed by the Visual Analogue Scale tended to be higher in the PCEA group than in the CEI group. Side effects such as nausea, hypotension, and itching were similar for the two groups.
  
  
  CONCLUSIONS
  We found that PCEA was an effective means of providing optimal analgesia, with better satisfaction during labor and less local anesthetic requirement.
authors: Department of Anesthesiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, 228-8555, Japan.
authors: Miwako
authors: M
authors: Saito
authors: Toshiyuki
authors: T
authors: Okutomi
authors: Yuji
authors: Y
authors: Kanai
authors: Junko
authors: J
authors: Mochizuki
authors: Akihiro
authors: A
authors: Tani
authors: Kan
authors: K
authors: Amano
authors: Sumio
authors: S
authors: Hoka
mesh_terms: D000328:Adult; D000577:Amides / Q000009:adverse effects; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D000779:Anesthetics, Local / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D010120:Oxytocics / Q000494:pharmacology; D010121:Oxytocin / Q000494:pharmacology; D010147:Pain Measurement; D017060:Patient Satisfaction; D011247:Pregnancy; D011537:Pruritus / Q000139:chemically induced / Q000453:epidemiology; D000077212:Ropivacaine
chemical_list: D000577:Amides; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D010120:Oxytocics; D010121:Oxytocin; D000077212:Ropivacaine; D005283:Fentanyl