Parturient Controlled Epidural Analgesia with and without Basal Infusion of Ropivacaine and Fentanyl: A Randomized Trial.

Abstract

Introduction:Parturient controlled epidural analgesia (PCEA) is an established method of providing safe and effective labor analgesia.Objective:The aim of this single-blind, randomized controlled trial was to compare the efficacy of PCEA with or without basal infusion (BI) of ropivacaine and fentanyl for the effective management of labor pain associated with normal vaginal delivery.Materials and Methods:A total of 78 nulliparous parturients with vertex presentation at term and with cervical dilatation of 3–5 cm demanding for epidural analgesia (EA) were enrolled in the study. EA was initiated and maintained with ropivacaine 0.125% and fentanyl 2 μg/mL. Following an initial epidural loading volume of 8–10 mL, parturients were randomly allocated in two groups of 39 each. PCEA group received bolus of 5 mL at 200 mL/h with lockout interval of 15 min and with maximum volume of local anaesthetic was 20 mL/h and PCEA + BI group – receiving added BI rate of 5 mL/h along with same programmed parameters of PCEA pump.Results:No statistically significant difference was observed between the groups in terms of demographic characteristics, duration of labor, delivery methods, maternal satisfaction as well as Apgar score. Mean demand bolus in group PCEA + BI was 0.39 ± 0.59, whereas in group PCEA was 3.31 ± 0.77 (P < 0.05). Mean volume of drug used in group PCEA + BI was 25.57 ± 2.75 mL, while in group PCEA was 22.42 ± 4.56 mL (P = 0.0005). In PCEA + BI group, Visual Analog Scale (VAS) score was 0.07 ± 0.35 at 60 min and 0.06 ± 0.33 at 120 min, whereas in PCEA group, VAS was 0.32 ± 0.62 at 60 min and 0.26 ± 0.50 at 120 min (P = 0.05), respectively.Conclusion:BI when added to PCEA, it significantly reduces breakthrough labor pain and demand boluses without prolonging labor duration but at the cost of increased requirement of drug volume when compared to PCEA only group.