title: A randomized control trial of patient-controlled epidural analgesia (PCEA) with and without a background infusion using levobupivacaine and fentanyl.
abstract: BACKGROUND
  Continuous infusion associated with patient-controlled epidural analgesia (PCEA) is used in many maternal units. This randomized controlled study evaluated the effect of a 10 mL/h background infusion associated with a 10 mL-20 minutes lockout time demand-only PCEA protocol using L-bupivacaine plus fentanyl in terms of local anaesthetic consumption, pain management and maternal satisfaction.
  
  
  METHODS
  Forty consenting parturients were randomly assigned to receive a 0.125% levobupivacaine plus 1.5 mcg/mL fentanyl PCEA (10 mL bolus with a 20 min lock time) with or without a 10 mL/h background infusion. The total volume of local anesthetic, the number of PCEA demand boluses, pain levels, delivery outcome and maternal satisfaction were evaluated.
  
  
  RESULTS
  The total volume of local anaesthetic was 35[20-120] mL in demand-only PCEA group versus 63.8[22.5-123] mL in PCEA plus background infusion group (P<0.001). This decrease in total volume was associated with an increase of self-administrated boluses in demand-only group (3.5[2-12] boluses, versus 1[0-3] bolus in PCEA plus background infusion group) (P<0.001). Pain scores were comparable between groups at any time of the study (P>0.05). Maternal satisfaction did not differ between groups (10[8-10] vs. 10[7-10]; P=0.11).
  
  
  CONCLUSIONS
  When a levobupivacaine plus fentanyl PCEA protocol with high volume boluses and long lockout interval is used for labour analgesia, the background infusion increased the total local anesthetic dose with no change in pain management and maternal satisfaction.
authors.affiliation: Department of Anesthesia and Resuscitation, La Paz University Hospital, Madrid, Spain. nicolas0brogly@hotmail.com
authors.forename: N
authors.initials: N
authors.lastname: Brogly
authors.forename: R
authors.initials: R
authors.lastname: Schiraldi
authors.forename: B
authors.initials: B
authors.lastname: Vazquez
authors.forename: J
authors.initials: J
authors.lastname: Perez
authors.forename: E
authors.initials: E
authors.lastname: Guasch
authors.forename: F
authors.initials: F
authors.lastname: Gilsanz
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D002585:Cesarean Section; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D000077554:Levobupivacaine; D010147:Pain Measurement; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077554:Levobupivacaine; D005283:Fentanyl; D002045:Bupivacaine