Authors: Halonen, P.¹; Sarvela, J.¹; Saisto, T.²; Soikkeli, A.¹; Halmesmäki, E.²; Korttila, K.¹

Source: Acta Anaesthesiologica Scandinavica, Volume 48, Number 6, July 2004 , pp. 732-737(6)

Publisher: Wiley-Blackwell

Abstract:

Background: 

We tested the hypothesis that patient-controlled epidural analgesia for labor (PCEA) provides better analgesia and satisfaction than the intermittent bolus technique (bolus) without affecting the mode of delivery. Methods: 

We randomized 187 parturients to receive labor analgesia using either the PCEA or bolus technique. The PCEA group received a starting bolus of 14 mg of bupivacaine and 60 µg of fentanyl in a 15-ml volume, followed by a background infusion (bupivacaine 0.08% and fentanyl 2 µg ml⁻¹) 5 ml h⁻¹ with a 5-ml bolus and 15-min lock-out interval. The bolus group received boluses of 20 mg of bupivacaine and 75 µg of fentanyl in a 15-ml volume. Results: 

Parturients in the PCEA group had significantly (P < 0.05-0.01) less pain during the first and second stages of labor. There was no difference in the spontaneous delivery rate between the groups, but the cesarean delivery rate was significantly (P < 0.05) higher (16.3% vs. 6.7%) in the PCEA group than in the bolus group. Bupivacaine consumption was significantly (P < 0.01) higher (11.2 mg h⁻¹ vs. 9.6 mg h⁻¹) and the second stage of labor was significantly (P < 0.01) longer (70 min vs. 54 min) in the PCEA group than in the bolus group. Patient satisfaction was equally good in both groups. Conclusion: 

The PCEA technique provided better pain relief. This was associated with higher bupivacaine consumption, prolongation of the second stage of labor, and an increased rate of cesarean section.

Keywords: Bupivacaine; fentanyl; mode of delivery; patient-controlled epidural analgesia

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.0001-5172.2004.00413.x

Affiliations: 1: Department of Anesthesia and Intensive Care and 2: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland

Publication date: 2004-07-01

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