title: Efficacy of patient controlled epidural analgesia during labor analgesia--a prospective randomized study using 0.1% bupivacaine with fentanyl 2 mg/ml.
abstract: BACKGROUND
  Epidural analgesia is the most effective for the control of pain during labor but irregularity of analgesia, toxicity of local anesthetics (LA) and driving block are the major limits of the modalities of maintenance.
  
  
  OBJECTIVE
  The purpose of this work was to assess the effectiveness and adverse effects of adaptations offered with Patient Controlled Epidural Analgesia (PCEA).
  
  
  METHODS
  40 mono-foetal parturients were randomized in two groups: 0.1% bupivacaine continuous drip associated to fentanyl 2 lg/mL (CP-group) or same products administrated in PCEA. Evaluation of analgesia, driving and sensory block allows adapting the outputs of drip.
  
  
  RESULTS
  Consumption schedule in LA was of 7.5+/-2 mL/h in the CP-group and 3.5+/-1.5 mL/h in PCEA-group (p < 0.05). Consumption accumulated by LA is reduced by 35 % from the very beginning and 43% a 4-th hour (p<0.05). Incidence of the driving block was of 11 cases in CP-group against 4 in PCEA-group per first hour and of 13 cases against 3 per second hour (p<0.001). 50% of clinical obstetric interventions were brought together in the CP-group against 5 % in the PCEA-group (p=0.013). Incidence of side effects is comparable.
  
  
  CONCLUSIONS
  Besides the perfect analgesia, PCEA offers a psychic independence which explains comfort and maternal satisfaction. Accumulation of LA entails a driving block involved in the change of dynamics of the labor. Incidence of clinical obstetric interventions is the major observation of our study.
authors.affiliation: Service d'Anesthésie Réanimation, Hôpital Mongi Slim, La Marsa.
authors.forename: Mhamed Sami
authors.initials: MS
authors.lastname: Mebazaa
authors.forename: Issam
authors.initials: I
authors.lastname: Tanoubi
authors.forename: Tahar
authors.initials: T
authors.lastname: Mestiri
authors.forename: Mohamed Faouzi
authors.initials: MF
authors.lastname: Gara
authors.forename: Mohamed Salah
authors.initials: MS
authors.lastname: Ben Ammar
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D048949:Labor Pain / Q000188:drug therapy* / Q000523:psychology; D007743:Labor, Obstetric; D017060:Patient Satisfaction; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D014416:Tunisia
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine