Double-blind evaluation of patient-controlled epidural analgesia during labor

Abstract

A double-blind randomized study was designed to compare the efficacy of patient-controlled epidural analgesia (PCEA) with continuous epidural analgesia (CEA) with regards to patient satisfaction with analgesia, analgesic efficacy, and local anesthetic usage. After establishing effective epidural analgesia with 8 ml of 0.25% bupivacaine, 39 parturients were randomized to 1 of 2 groups. The CEA group received a continuous infusion of 12 ml/h of 0.125% bupivacaine. The PCEA group received a background infusion of 4 ml/h of 0.125% bupivacaine and were able to self-administer additional boluses of 3 ml of 0.25% bupivacaine every 10 min up to 15 ml/h. In both groups, when patients complained of inadequate analgesia, supplemental doses of 5 ml of 0.25% bupivacaine were administered by a physician. The 2 groups were similar in age, height, weight, gravidity, labor duration, motor block, sensory block, and infant Apgar scores. The 2 groups also did not differ significantly in terms of patient satisfaction, pain assessment, or total drug usage. However, the PCEA group required significantly fewer supplemental doses (15%) compared with the CEA group (40%). The decreased need for supplemental doses in the PCEA group may suggest a potential advantage in consistency of analgesia and possibly decreased man-power needs.