Patient-controlled epidural analgesia during labor using ropivacaine and fentanyl provides better maternal satisfaction with less local anesthetic requirement.
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.
Saito
Miwako
M
Department of Anesthesiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, 228-8555, Japan.
Okutomi
Toshiyuki
T
Kanai
Yuji
Y
Mochizuki
Junko
J
Tani
Akihiro
A
Amano
Kan
K
Hoka
Sumio
S
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
D000577:Amides; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D010120:Oxytocics; D010121:Oxytocin; D000077212:Ropivacaine; D005283:Fentanyl