SMFM: Patient-Controlled Epidural Lowers Drug Use

Women use 30 percent less analgesia during labor, with similar satisfaction level

FRIDAY, Feb. 11 (HealthDay News) -- Women who administer their own analgesia (patient-controlled epidural analgesia [PCEA]) during labor as compared to being administered a continuous epidural infusion (CEI) use less analgesia but experience similar levels of satisfaction, according to research presented at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting, held from Feb. 7 to 12 in San Francisco.

Michael Haydon, M.D., of the Long Beach Memorial Medical Center in California, and colleagues randomized 270 nulliparous women to one of three groups. Initially, women were administered an intrathecal dose of 2 mg bupivicaine/20 µg fentanyl was given followed by maintenance epidural infusion of 0.1 percent bupivicaine/2 µg/mL fentanyl. Women in group one received CEI background only, with women in group two receiving CEI-PCEA and women in group three receiving PCEA only.

The investigators found that the total mg of bupivicaine used was less in the PCEA-only group compared to CEI. However, no differences in total time of labor or cesarean delivery were found between the three groups. While the investigators found that pain with pushing was worse in the PCEA-only group, lower extremity strength and urge to push did not differ with method of epidural. Subjects with CEI had a slightly higher number of instrumented vaginal deliveries. PCEA resulted in a 30 percent decrease in analgesia used during labor but resulted in similar levels of satisfaction.

"Though patients in each group showed equal satisfaction, we did note that there was more pain during the final delivery stage in the PCEA group," Haydon said in a statement. "The next step is to look at shortening the lock-out intervals between doses, or having the option of administering additional analgesia during the final pushing stage."

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