Patient Controlled-epidural Analgesia with or without a Background Infusion for Labour Analgesia
Figen Önder
Department of Anaesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, Turkey.
Nurten Kayacan *
Department of Anaesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, Turkey.
Bilge Karsli
Department of Anaesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, Turkey.
Zekiye Bigat
Department of Anaesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, Turkey
*Author to whom correspondence should be addressed.
Abstract
The popularity of Patient-Controlled Epidural Analgesia (PCEA) has increased in the treatment of labour pain.
50 ASA I primaparous or multiparous parturients who had requested epidural analgesia were enrolled in this prospective study. Group I (demand-only PCEA) received a PCEA regimen without background infusion, 6-mL demand bolus, 10-min lockout interval, Group II (PCEA-CBI) received a similar PCEA regimen with continuous background infusion of 6 mL/h. The epidural solution consisted of 0.1% levobupivacaine with fentanyl 2 microg/mL. Primary outcomes investigated were efficacy of epidural analgesia using VAPS and the number of PCEA demand, the number of delivered PCEA boluses and total consumption of local anaesthetic and patient’s satisfaction.
Baseline VAPS scores of the patients were similar. At no time throughout labour there was a significant difference in the mean VAPS scores between groups. VAPS scores decreased significantly within first 15 min. following epidural analgesia and all parturients had low pain scores (VAPS<3) during the overall study period. The number of PCEA demand and the number of PCEA delivery dose were higher in demand-only PCEA group. All of this differences were not significant statistically. However, the mean total amount of local anesthetic and opioid solution administered during the overall study period was less in parturients receiving demand-only PCEA group but there was no statistical difference. Maternal satisfaction values were high and similar between study groups.
PCEA plus CBI is not essential to achieve a good analgesia for labour and delivery. The use of demand-only PCEA with 6mL bolus and 10 minutes can relief of labour pain and improve the comfort of parturients and their satisfaction during labour with less drug consumption.
Keywords: Labour analgesia, epidural analgesia, patient-controlled analgesia, levobupivacaine, fentanyl