title: Obstetric outcomes and maternal satisfaction in nulliparous women using patient-controlled epidural analgesia.
abstract: OBJECTIVE
  The purpose of this study was to compare obstetric outcomes and maternal satisfaction in nulliparous women in spontaneous labor who used patient-controlled epidural analgesia (PCEA) vs continuous epidural infusion (CEI).
  
  
  METHODS
  We conducted a double-masked trial of 270 nulliparous women who were assigned randomly to 3 groups (with a concentration 0.1% bupivacaine and 2 μg/mL fentanyl): group I, CEI-only (10 mL/h); group II, CEI + PCEA (CEI 10 mL/h plus PCEA 10 mL, at 20 minutes); group III, PCEA-only (10 mL, at 20 minutes). A PCEA bolus button was given to each subject. The primary outcome was the dosage of local anesthetic that was used.
  
  
  RESULTS
  The total milligrams of bupivacaine that were used was less in the PCEA-only group compared with CEI: group I. 74.8 ± 36 mg; group II, 97.3 ± 53 mg; group III, 52.4 ± 42 mg (P < .001). Pain with pushing, however, was worse in the PCEA-only group. Median satisfaction scores were similar (scale, 0 [best] to 100 [worst]: group I, 0; group II, 0; group III, 0 (P = .23).
  
  
  CONCLUSIONS
  PCEA results in less anesthetic used, and maternal satisfaction remains high without a continuous infusion. Pain with pushing, however, was worse with the PCEA alone.
authors: Department of Obstetrics and Gynecology, Long Beach Memorial Medical Center, Long Beach, CA, USA.
authors: Michael L
authors: ML
authors: Haydon
authors: David
authors: D
authors: Larson
authors: Enrique
authors: E
authors: Reed
authors: Vineet K
authors: VK
authors: Shrivastava
authors: Christine W
authors: CW
authors: Preslicka
authors: Michael P
authors: MP
authors: Nageotte
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D036861:Delivery, Obstetric; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D010147:Pain Measurement; D010298:Parity; D017060:Patient Satisfaction; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine