Recent advances in patient-controlled epidural analgesia for labour.
OBJECTIVE
Patient-controlled epidural analgesia (PCEA) is a relatively new mode of maintenance of labour analgesia. The purpose of this review is to demonstrate that PCEA has several advantages over continuous-infusion analgesia and to discuss recent refinements in the use of PCEA for labour.


RESULTS
Early investigations showed that PCEA without background infusion reduced the incidence of motor block and the amount of local anaesthetic needed to produce satisfactory analgesia compared to continuous infusions. Recent studies have shown that the addition of a background infusion to PCEA may be advantageous, depending on the patient population and the rate of the continuous infusion. Both bupivacaine and ropivacaine have been used in PCEA but ropivacaine may be associated with a reduced incidence of motor block in parturients who have epidural analgesia for long periods of time. Of note, very low concentrations of local anaesthetics are required to produce satisfactory analgesia.


CONCLUSIONS
PCEA has proven to be a safe, convenient, and highly effective way to maintain labour analgesia. Parturients appreciate the control they have over the analgesia received throughout labour when this method is used.
Department of Anaesthesia, Sunnybrook and Women's College Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada. Stephen.Halpern@sw.ca
Stephen
S
Halpern