Regimens for Patient-controlled Epidural Analgesia during Labor

Abstract

We would like to thank Dr. Paech for his comment on our study, and to apologize for not having cited his previous study devoted to the role of background infusion during labor patient-controlled analgesia performed more than 10 yr before ours.1,2Although a smaller sample size, a different anesthetic solution (0.125% bupivacaine and fentanyl 3 μg/ml) and only one rate of background infusion were studied, Paech had shown no benefit of using a background infusion in combination with self-administered boluses with equivalent analgesia and satisfaction in both groups, low rates of bupivacaine usage, and similar maternal and neonatal outcomes. No differences were observed in the mean ± SD hourly bupivacaine doses (11 ± 5 mg in the bolus groups and 13 ± 7 mg in the bolus plus 4-ml/h background infusion group, not significant), which was similar to our study, where no differences were observed in the hourly consumption of anesthetic solution between the 0-ml/h and 3-ml/h groups. This might be explained by insufficient power of both studies to detect small differences in the hourly requirements. However, the results from both studies and from the two previous studies devoted to this subject provide evidence that background infusion may not be routinely used during labor patient-controlled analgesia.3,4* Hôtel-Dieu Hospital, Lyon, France. dominique.chassard@chu-lyon.fr