title: Intermittent vs continuous administration of epidural ropivacaine with fentanyl for analgesia during labour.
abstract: BACKGROUND
  Many years ago regular intermittent bolus administration of epidural local anaesthetic solution was recognized to produce more effective analgesia than continuous infusion, but only recently has the development of suitable pumps allowed the former technique's wider evaluation.
  
  
  METHODS
  In this randomized, double-blind trial, 40 primigravid patients had a lumbar epidural catheter inserted, and plain ropivacaine 0.2% 15-20 ml was titrated until analgesia and bilateral sensory block to T10 were produced (time zero). Patients were then given either an infusion of ropivacaine 2 mg ml(-1) with fentanyl 2 microg ml(-1) at 10 ml h(-1), or hourly boluses of 10 ml of the same solution. Pain, sensory block and motor block were measured frequently. If requested, additional 10 ml boluses of the study mixture were given for analgesia.
  
  
  RESULTS
  There were no differences between the two groups in patient characteristics, obstetric/neonatal outcome, or in sensory or motor block. A total of 12 (60%) patients in the continuous group required one or more additional boluses compared with 4 (20%) patients in the intermittent group (95% CI 9.6-61.7%, P=0.02). Therefore the intermittent group received a lower total drug dose than the infusion group (P=0.02). Duration of uninterrupted analgesia (time to first rescue bolus) was longer in the intermittent group (P<0.02).
  
  
  CONCLUSIONS
  The intermittent group required fewer supplementary injections and less drug to maintain similar pain scores, sensory and motor block compared with the continuous group. This represents a more efficacious mode of analgesia.
authors.affiliation: University Department of Anaesthesia, Ninewells Hospital and Medical School Dundee DD1 9SY, UK. pdwfettes@doctors.org.uk
authors.forename: P D W
authors.initials: PD
authors.lastname: Fettes
authors.forename: C S
authors.initials: CS
authors.lastname: Moore
authors.forename: J B
authors.initials: JB
authors.lastname: Whiteside
authors.forename: G A
authors.initials: GA
authors.lastname: McLeod
authors.forename: J A W
authors.initials: JA
authors.lastname: Wildsmith
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007260:Infusion Pumps; D010147:Pain Measurement; D011247:Pregnancy; D011256:Pregnancy Outcome; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl