Epidural labor analgesia: continuous infusion versus patient-controlled epidural analgesia with background infusion versus without a background infusion.
The purpose of this study was to compare the total epidural dose of 3 commonly used labor epidural modalities. After local institutional review board approval, 195 laboring parturients received an epidural catheter for labor analgesia. All patients received an initial bolus of 0.1% ropivacaine (10 mL) and fentanyl (100 microg). Maintenance of labor analgesia consisted of ropivacaine 0.1% with fentanyl 2 microg/mL. Patients were then randomly assigned into 3 groups: Group 1 (continuous epidural infusion [CEI]), continuous infusion at 10 mL/h; group 2 (CEI + patient-controlled epidural analgesia [PCEA]), CEI at 5 mL/h with a demand dose of 5 mL allowed every 20 minutes with a 20 mL/h maximum dose; group 3 (PCEA), demand doses only of 5 mL every 15 minutes with a 20 mL/h maximum dose. Measured variables included total epidural dose, total bolus requests and boluses delivered, number of staff interventions, pain Visual Analog Scale (VAS; 0-100), modified Bromage scores, stage I and II labor duration, delivery outcome, and maternal satisfaction after delivery. No differences were noted with respect to pain VAS, modified Bromage scores, stage I and II labor duration, number of staff interventions, delivery outcome, and maternal satisfaction score. Total infusion dose was lower in demand dose only PCEA compared with CEI and CEI + PCEA groups (P = < .01). Demand dose-only PCEA results in less total epidural dose compared with CEI and CEI + PCEA without affecting labor duration, motor block, pain VAS, maternal and neonatal outcomes, and maternal satisfaction.


CONCLUSIONS
This article compares 3 commonly used labor epidural delivery modalities (traditional continuous epidural infusion, patient-controlled epidural analgesia with a background infusion, and demand dose-only patient-controlled epidural analgesia). Benefits in epidural dose reduction with demand dose only PCEA does not translate into improved maternal and neonatal outcome.
Department of Anesthesiology, Magee-Womens Hospital of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. vallejomc@anes.upmc.edu
Manuel C
MC
Vallejo
Vimala
V
Ramesh
Amy L
AL
Phelps
Neera
N
Sah
D000328:Adult; D000577:Amides / Q000008:administration & dosage; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000777:Anesthetics / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy* / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D000077212:Ropivacaine; D013997:Time Factors; D016896:Treatment Outcome
D000577:Amides; D000777:Anesthetics; D000077212:Ropivacaine; D005283:Fentanyl