Patient-controlled epidural analgesia following combined spinal-epidural analgesia in labour: the effects of adding a continuous epidural infusion

Anaesth Intensive Care. 2005 Aug;33(4):452-6. doi: 10.1177/0310057X0503300405.

Abstract

Patient-controlled epidural analgesia (PCEA) is used to maintain epidural analgesia following initial intrathecal analgesia. This trial investigated whether a continuous background infusion with PCEA provides superior analgesia to PCEA alone among patients who received combined spinal-epidural (CSE) analgesia during labour Eighty parturients were randomized to either PCEA alone (PCEA) or PCEA with a background infusion of ropivacaine 0.15% with sufentanil 0.75 microg/ml at 2 ml/h (PCEA + CEI). PCEA settings were a bolus of 4 ml of the same analgesic solution with a lockout interval of 15 minutes. Significantly more patients in the PCEA group required at least one anaesthetist intervention for breakthrough pain (27 [71%] vs 10 [25%] in the PCEA + CEI group, P<0.05). Consumption of local anaesthetic (excluding manually administered boluses) was similar between the groups. If anaesthetist-administered boluses were included, more local anaesthetic was consumed by the PCEA group (47.1 +/- 19.4 mg vs 35.6 +/- 12.0 mg in the PCEA + CEI group, P<0.05). We conclude that PCEA with a background infusion provides effective analgesia with less anaesthetist workload and reduced local anaesthetic consumption as compared with PCEA without a background infusion.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Amides / administration & dosage
  • Analgesia, Epidural / adverse effects
  • Analgesia, Epidural / methods*
  • Analgesia, Obstetrical / adverse effects
  • Analgesia, Obstetrical / methods*
  • Analgesia, Patient-Controlled / adverse effects
  • Analgesia, Patient-Controlled / methods*
  • Analgesics, Opioid / administration & dosage
  • Anesthetics, Combined / administration & dosage
  • Anesthetics, Combined / therapeutic use*
  • Anesthetics, Local / administration & dosage
  • Double-Blind Method
  • Female
  • Humans
  • Infusions, Intravenous / methods
  • Injections, Spinal / methods
  • Pain / prevention & control
  • Pain Measurement / statistics & numerical data
  • Ropivacaine
  • Sufentanil / administration & dosage
  • Sufentanil / adverse effects
  • Time Factors
  • Treatment Outcome

Substances

  • Amides
  • Analgesics, Opioid
  • Anesthetics, Combined
  • Anesthetics, Local
  • Ropivacaine
  • Sufentanil