Patient-controlled epidural analgesia during labor.

Abstract

This study compared the safety, efficacy, local anesthetic usage, patient satisfaction, and anesthesia manpower demands of patient-controlled epidural analgesia and continuous epidural infusion during labor. After establishment of epidural analgesia, 88 parturients with vertex presentation were assigned randomly to receive either patient-controlled epidural analgesia or continuous epidural infusion, using 0.125% bupivacaine containing 1 microgram/mL of fentanyl. Inadequate analgesia was treated in both groups with a 10-mL "top-up" of 0.25% bupivacaine. Patients receiving patient-controlled epidural analgesia required significantly fewer supplemental top-up doses (36 versus 71%; P less than .05) and insignificantly less local anesthetic (13.6 +/- 0.6 versus 14.6 +/- 0.5 mL/hour; P = .10). The two groups did not differ in incidence of hypotension, high sensory blockade (above T8), mode of delivery, or patient satisfaction assessed by questionnaire. Use of local anesthetic solution was examined with respect to cervical dilatation and did not increase late in labor. Patients generally viewed infusion technology favorably. These findings suggest that patient-controlled epidural analgesia is safe and effective, reduces anesthesia manpower needs, and is well accepted.