Patient-controlled epidural analgesia in labor

Abstract

Patient-controlled epidural analgesia (PCEA) for labor was first described in 1988. The technique has a number of advantages when compared with intermittent clinician top-ups or continuous epidural infusion. The main advantage of PCEA is that patients tend to receive less local anesthetic and therefore are less likely to experience motor block, even after prolonged administration. This often leads to higher maternal satisfaction scores and may impact positively on obstetric outcome. Finally, PCEA may reduce the number of clinician interventions, thereby reducing workload. When compared with other modalities of analgesia maintenance, PCEA seems to be equally safe for both mother and baby. The primary drawback of PCEA devices is the cost associated with the equipment. Success of the technique depends on adequate education for both the patient and staff. Some patients prefer not to participate in administration of their own medications and should not be offered PCEA. PCEA is a very versatile option for labor analgesia. The drug concentrations, lockout intervals, size of the bolus dose, and the background rate of infusion must be specified. Some of the practical aspects of the technique are outlined. Copyright © 2001 by W.B. Saunders Company