Patient-controlled epidural analgesia is the technique of choice for epidural analgesia in labour

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Epidural analgesia for labour may be maintained by intermittent boluses, continuous infusions or patientcontrolled epidural analgesia (PCEA). Each technique has its advantages and disadvantages. Intermittent boluses have the disadvantage of requiring the immediate presence of an anaesthetist or midwife in order to provide an epidural top-up on request. If personnel are not immediately available, pain intensity increases and epidural analgesia becomes less satisfactory. On first glance, these problems might be solved by continuous infusion, a technique that has been accepted broadly in the majority of hospitals and is currently used by 34% of German anaesthesia departments. 1 As pain thresholds differ between individual patients and pain intensity depends on (a) labour augmentation (b) the presence of dystocia, and (c) the stage of labour, continuous infusions fall short of tailoring the requirements to the needs of the individual mother. 2 Therefore, infusion rates are frequently placed on a higher setting in order to serve the needs of most labouring mothers. The higher total doses of delivered local anaesthetics may offset the benefits obtained by using low concentrations of the local anaesthetic agent. In the COMET study, patients who were given a low dose continuous infusion of bupivacaine 0.1% plus fentanyl, received total doses of bupivacaine that were comparable to those used in a traditional regimen with bupivacaine 0.25% maintained by intermittent boluses. 3 PCEA has several advantages over continuous infusions. It is associated with less local anaesthetic consumption and motor blockade while providing higher patient satisfaction. This is due to the enhanced control of pain by the patient and her independence from medical staff. 4 Even though total doses of local anaesthetics are reduced, the extent of sensory block is well maintained and pain relief is similar to that of continuous infusion. 5 The decreased consumption of local anaesthetic with PCEA is approximately 35% compared to continuous infusion and is similar to that reported with combined-spinal epidural analgesia. 6,7 This may explain the improved mobility and reduced duration of labour with the PCEA technique that has been observed by some authors. 8