A double-blind randomized controlled trial of patient-controlled epidural analgesia with or without a background infusion following initial spinal analgesia for labor pain

T. Okutomi, M. Saito, J. Mochizuki, K. Amano, Sumio Hoka

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Patient-controlled epidural analgesia (PCEA) combined with spinal analgesia is an option for pain relief in labor. However, the effect of a CBI on the analgesic requirements of laboring women is still debated. This double-blind study investigated the effect of CBI with PCEA following spinal analgesia on the local anesthetic requirements of parturients during labor. Methods: Sixty-six nulliparous women were randomly assigned to a standard PCEA protocol (5-mL demand bolus, 10-min lockout) with or without a CBI of 6 mL/h. The epidural solution consisted of 0.1% ropivacaine with fentanyl 2 μg/mL. Labor analgesia was initiated in both groups with intrathecal bupivacaine 2.5 mg plus fentanyl 25 μg. The number of demands per hour and the hourly dose of ropivacaine were calculated for both groups. Results: The median [range] number of analgesic boluses per hour in the PCEA group that were demanded: 2.4 [0.8-12.2] and delivered: 1.6 [0.8-2.6], were significantly greater than those in the PCEA+CBI group: 0.7 [0.4-4.2] and 0.6 [0.2-1.3] (P 0.05). However, the hourly ropivacaine dose in the PCEA group (7.9 [3.9-13.2] mg/h) was not significantly different from that in the PCEA+CBI group (8.4 [6.0-12.5] mg/h). Conclusion: In laboring nulliparous patients provided initial labor analgesia with spinal anesthesia, the use of a continuous background infusion decreases PCEA demand dosing, but not the total hourly amount of ropivacaine and fentanyl used.

Original languageEnglish
Pages (from-to)28-32
Number of pages5
JournalInternational Journal of Obstetric Anesthesia
Volume18
Issue number1
DOIs
Publication statusPublished - Jan 1 2009

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Labor Pain
Patient-Controlled Analgesia
Epidural Analgesia
Analgesia
Randomized Controlled Trials
Fentanyl
Analgesics
Spinal Anesthesia
Bupivacaine
Local Anesthetics
Double-Blind Method
Parturition
Pain
ropivacaine

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine
  • Obstetrics and Gynaecology

Cite this

A double-blind randomized controlled trial of patient-controlled epidural analgesia with or without a background infusion following initial spinal analgesia for labor pain. / Okutomi, T.; Saito, M.; Mochizuki, J.; Amano, K.; Hoka, Sumio.

In: International Journal of Obstetric Anesthesia, Vol. 18, No. 1, 01.01.2009, p. 28-32.

Research output: Contribution to journalArticle

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abstract = "Background: Patient-controlled epidural analgesia (PCEA) combined with spinal analgesia is an option for pain relief in labor. However, the effect of a CBI on the analgesic requirements of laboring women is still debated. This double-blind study investigated the effect of CBI with PCEA following spinal analgesia on the local anesthetic requirements of parturients during labor. Methods: Sixty-six nulliparous women were randomly assigned to a standard PCEA protocol (5-mL demand bolus, 10-min lockout) with or without a CBI of 6 mL/h. The epidural solution consisted of 0.1{\%} ropivacaine with fentanyl 2 μg/mL. Labor analgesia was initiated in both groups with intrathecal bupivacaine 2.5 mg plus fentanyl 25 μg. The number of demands per hour and the hourly dose of ropivacaine were calculated for both groups. Results: The median [range] number of analgesic boluses per hour in the PCEA group that were demanded: 2.4 [0.8-12.2] and delivered: 1.6 [0.8-2.6], were significantly greater than those in the PCEA+CBI group: 0.7 [0.4-4.2] and 0.6 [0.2-1.3] (P 0.05). However, the hourly ropivacaine dose in the PCEA group (7.9 [3.9-13.2] mg/h) was not significantly different from that in the PCEA+CBI group (8.4 [6.0-12.5] mg/h). Conclusion: In laboring nulliparous patients provided initial labor analgesia with spinal anesthesia, the use of a continuous background infusion decreases PCEA demand dosing, but not the total hourly amount of ropivacaine and fentanyl used.",
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