title: Comparison of computer-integrated patient-controlled epidural analgesia with no initial basal infusion versus moderate basal infusion for labor and delivery: A randomized controlled trial.
abstract: OBJECTIVE
  Computer-integrated patient-controlled epidural analgesia (CIPCEA) is a novel epidural drug delivery system. It automatically adjusts the basal infusion based on the individual's need for analgesia as labor progresses.
  
  
  METHODS
  This study compared the time-weighted local anesthetic (LA) consumption by comparing parturients using CIPCEA with no initial basal infusion (CIPCEA0) with CIPCEA with initial moderate basal infusion of 5 ml/H (CIPCEA5). We recruited 76 subjects after ethics approval. The computer integration of CIPCEA titrate the basal infusion to 5, 10, 15, or 20 ml/H if the parturient required respectively, one, two, three, or four patient demands in the previous hour. The basal infusion reduced by 5 ml/H if there was no demand in the previous hour. The sample size was calculated to show equivalence in LA consumption.
  
  
  RESULTS
  The time-weighted LA consumption between both groups were similar with CIPCEA0 group (mean [standard deviation (SD)] 8.9 [3.5] mg/H) compared to the CIPCEA5 group (mean [SD] 9.9 [3.5] mg/H), P = 0.080. Both groups had a similar incidence of breakthrough pain, duration of the second stage, mode of delivery, and patient satisfaction. However, more subjects in the CIPCEA0 group required patient self-bolus. There were no differences in fetal outcomes.
  
  
  CONCLUSIONS
  Both CIPCEA regimens had similar time-weighted LA consumption and initial moderate basal infusion with CIPCEA may not be required.
authors.affiliation: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore ; Anesthesiology Program, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Ban Leong
authors.initials: BL
authors.lastname: Sng
authors.affiliation: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.
authors.forename: David
authors.initials: D
authors.lastname: Woo
authors.affiliation: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.
authors.forename: Wan Ling
authors.initials: WL
authors.lastname: Leong
authors.affiliation: Anesthesiology Program, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore ; Singapore Clinical Research Institute, Singapore.
authors.forename: Pryseley Nkouibert
authors.initials: PN
authors.lastname: Assam
authors.affiliation: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore ; Anesthesiology Program, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Alex Th
authors.initials: AT
authors.lastname: Sia
keywords: Anesthesia; epidural; obstetrical