Patient-Controlled Epidural Analgesia During Labor

Abstract

In order to assess the safety and efficacy of patient-controlled epidural analgesia (PCEA) during labor, the authors studied a series of healthy parturients with singleton fetuses in vertex presentation. At cervical dilation of 3–7 cm, epidural catheters were inserted at L2-L5 and proper placement determined by establishment of at least bilateral T10 analgesia with 0.25% bupivacaine. The patients were then randomly assigned to one of 4 groups. Group CEI (continuous epidural infusion) received 0.125% bupivacaine titrated hourly by a physician. The three CEA groups received 0.125% bupivacaine alone or in combination with fentanyl (1 μg/ml) or with fentanyl-epinephrine (1:400,000). PCA pumps were set to deliver a 6 ml/h base infusion with 4 ml patient boluses, a 10 minute lockout period and a 20 ml/h limit. Physicians were blinded as to the PCEA infusion content and injected 0.25% bupivacaine just before delivery for perineal analgesia. Patients reported pain intensity on a 1–10 verbal scale just before epidural catheterization, at the initiation of infusion and then hourly. Additional data gathered included FHR, maternal HR and BP, sensory and motor levels, presence and extent of hypotension, and side effects such as nausea, pruritus or respiratory depression. On postpartum day 1 all patients assessed overall labor analgesia as 0 (unsatisfactory) to 3 (excellent).