A double-blind randomized controlled trial of patient-controlled epidural analgesia with or without a background infusion following initial spinal analgesia for labor pain

Okutomi, Toshiyuki; Saito, Miwako; Mochizuki, Junko; Amano, Kazutaka; Hoka, Sumio

doi:10.1016/j.ijoa.2008.06.006

Cited by 21 publications

(15 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5 In contrast to the COMET study, a number of other studies have shown no difference in AVD. [11][12][13][14] These studies differed in the local anesthetic utilized, the concentrations of local anesthetic solution, or the varying combinations of bolus and/or continuous background infusion rates. Although the COMET study showed that the concentration of local anesthetic had an effect on AVD in nulliparous women, it was performed in only two tertiary delivery centres within the U.K., which may limit the broad generalizability of their findings to other obstetric populations and practices within and outside the U.K. A recent review by Loubert et al highlighted the need for further studies to elucidate the impact of epidural solutions and regimens on outcomes such as the rate of AVD and the duration of labour.…”

Section: Résumémentioning

confidence: 99%

The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis

Sultan

Murphy

Halpern

et al. 2013

Can J Anesth/J Can Anesth

114

View full text Add to dashboard Cite

Introduction The influence that different concentrations of labour epidural local anesthetic have on assisted vaginal delivery (AVD) and many obstetric outcomes and side effects is uncertain. The purpose of this meta-analysis was to determine whether local anesthetics utilized at low concentrations (LCs) during labour are associated with a decreased incidence of AVD when compared with high concentrations (HCs). Methods We searched PubMed, Ovid EMBASE, Ovid MEDLINE, CINAHL, Scopus, clinicaltrials.gov, and Cochrane databases for randomized controlled trials of labouring patients that compared LCs (defined as B 0.1% epidural bupivacaine or B 0.17% ropivacaine) of epidural local anesthetic with HCs for maintenance of analgesia. The primary outcome was AVD and secondary outcomes included Cesarean delivery, duration of labour, analgesia, side effects (nausea and vomiting, motor block, hypotension, pruritus, and urinary retention), and neonatal outcomes. The odds ratios (OR) or weighted mean differences (WMD) and 95% confidence intervals (CI) were calculated using random effects modelling. An OR \ 1 or a WMD \ 0 favoured LCs. Results Eleven studies met our criteria (eight bupivacaine and three ropivacaine studies), providing 1,145 patients in the LCs group and 852 patients in the HCs group for analysis of the primary outcome. Low concentrations were associated with a reduction in the incidence of AVD (OR = 0.70; 95% CI 0.56 to 0.86; P \ 0.001). There was no difference in the incidence of Cesarean delivery (OR 1.05; 95% CI 0.82 to 1.33; P = 0.7). The LCs group had less motor block (OR 3.9; 95% CI 1.59 to 9.55; P = 0.003), greater ambulation (OR 2.8; 95% CI 1.1 to 7.14; P = 0.03), less urinary retention (OR 0.42; 95% CI 0.23 to 0.73; P = 0.002), and a shorter second stage of labour (WMD -14.03; 95% CI -27.52 to -0.55; P = 0.04) compared with the HCs group. There were no differences between groups in pain scores, maternal nausea and vomiting, hypotension, fetal heart rate abnormalities, five-minute Apgar scores, and need for neonatal resuscitation. One-minute Apgar scores \ 7 favoured the HCs group (OR 1.53; 95% CI 1.07 to 2.21; P = 0.02), and there was more pruritus in the LCs group (OR 3.36; 95% CI 1.00 to 11.31; P = 0.05). Conclusion When compared with HCs of local anesthetics, the use of LCs for labour epidural analgesia reduces the incidence of AVD. This may be due to a Author contributions Pervez Sultan, Caitriona Murphy, Stephen Halpern, and Brendan Carvalho made substantial contributions to the conception and design of the study and were involved in drafting the article for important intellectual content. -013-9981-z reduction in the amount of local anesthetic used and the subsequent decrease in motor blockade. We therefore recommend the use of LCs of local anesthetics for epidural analgesia to optimize obstetric outcome.123 Can J Anesth/J Can Anesth (2013) 60:840-854 DOI 10.1007/s12630 RésuméObjectif Nous connaissons mal l'influence de différentes concentrations d'anesthésique local pour la péridurale...

show abstract

Section: Résumémentioning

confidence: 99%

The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis

Sultan

Murphy

Halpern

et al. 2013

Can J Anesth/J Can Anesth

114

View full text Add to dashboard Cite

show abstract

“…Although lower consumption of local anesthetic was reported in women who received PCEA without the basal infusion, none of the other outcomes were significantly better in patients who received PCEA without the basal infusion. A double-blind randomized controlled trial was carried out by Okutomi et al [7] on 67 nulliparous women, who received a standard PCEA protocol (5-ml demand bolus, 10-min lockout interval) with or without a continuous basal infusion (CBI) of 6 ml/h after initial spinal analgesia (part of CSE technique). The median number of analgesic boluses per hour (as assessed with the demanded : delivered ratio) was significantly higher in the demand-only group.…”

Section: Patient-controlled Epidural Analgesia Plus Basal Infusionmentioning

confidence: 99%

Techniques for the maintenance of epidural labor analgesia

Capogna

Stirparo

2013

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4] Additionally, PCEA leads to decreased anesthetic administration, smaller rescue doses, and a lower incidence of motor blockade. 2,[5][6][7][8] PCEA has been used during labor with or without continuous background infusion, 1,4,[7][8][9][10] with boluses of different volumes, and with variable lockout intervals.…”

Section: Introductionmentioning

confidence: 99%

Effects of Local Anesthetic on the Time Between Analgesic Boluses and the Duration of Labor in Patient-Controlled Epidural Analgesia: Prospective Study of Two Ultra-Low Dose Regimens of Ropivacaine and Sufentanil

Costa-Martins¹,

Dias

Pereira

et al. 2015

Acta Med Port

View full text Add to dashboard Cite

(1):70-76 RESUMOIntrodução: A patient-controlled epidural analgesia com baixas concentrações de anestésicos é eficaz na redução da dor de parto. O objectivo deste estudo foi comparar dois regimes de doses ultrabaixas de ropivacaína e sufentanil (0,1% ropivacaína associada a 0,5 µg.ml -1 sufentanil vs. 0,06% ropivacaína associada a 0,5 µg.ml -1 sufentanil) nos intervalos entre bólus e na duração do trabalho de parto. Material e Métodos: Neste estudo prospectivo não-randomizado, realizado entre Janeiro e Julho de 2010, dois grupos de parturientes receberam patient-controlled epidural analgesia: o Grupo I (n = 58; 1 mg.ml -1 ropivacaína + 0,5 µg.ml -1 sufentanil) e o Grupo II (n = 57; 0,6 mg.ml -1 ropivacaína + 0,5 µg.ml -1 sufentanil). Quando necessário administraram-se doses de resgate de ropivacaína na concentração definida para cada grupo e sem sufentanil. Registaram-se a dor, os consumos de analgésicos, as características do bloqueio neuroaxial, do trabalho de parto, do recém-nascido, e a satisfação materna. Resultados: A dose de ropivacaína foi maior no Grupo I (9,5 [7,7-12,7] No Grupo I observouse um aumento do intervalo de tempo entre bólus (beta = 32,61 min, 95% CI [25,39; 39,82], p < 0,001), enquanto no Grupo II se observou uma diminuição dos intervalos (beta = -1,40 min, 95% CI [-2,44; -0,36], p = 0,009). A duração do segundo estadio do trabalho de parto foi significativamente maior no Grupo I do que no Grupo II (78 min vs. 65 min, p < 0,001). Conclusões: As parturientes que receberam ropivacaína a 0,06% exibiram uma menor evidência de efeitos cumulativos e um segundo estadio do trabalho de parto mais rápido do que as que receberam ropivacaína a 0,1%. Palavras-chave: Analgesia Controlada pelo Doente; Analgesia Obstétrica; Dor do Parto; Ropivacaína; Sufentanil. ABSTRACTBackground: Patient-controlled epidural analgesia with low concentrations of anesthetics is effective in reducing labor pain. The aim of this study was to assess and compare two ultra-low dose regimens of ropivacaine and sufentanil (0.1% ropivacaine plus 0.5 µg.ml-1 sufentanil vs. 0.06% ropivacaine plus 0.5 µg.ml -1 sufentanil) on the intervals between boluses and the duration of labor. Material and Methods: In this non-randomized prospective study, conducted between January and July 2010, two groups of parturients received patient-controlled epidural analgesia: Group I (n = 58; 1 mg.ml -1 ropivacaine + 0.5 µg.ml -1 sufentanil) and Group II (n = 57; 0.6 mg.ml -1 ropivacaine + 0.5 µg.ml -1 sufentanil). Rescue doses of ropivacaine at the concentration of the assigned group without sufentanil were administered as necessary. Pain, local anesthetic requirements, neuraxial blockade characteristics, labor and neonatal outcomes, and maternal satisfaction were recorded. Results: The ropivacaine dose was greater in ] mg.h -1 vs. 6.1 [5.1-9.8 mg.h -1 ], p < 0.001). A time increase between each bolus was observed in Group I (beta = 32.61 min, 95% CI [25.39; 39.82], p < 0.001), whereas a time decrease was observed in Group II (beta = -1.40 min, 95% CI ...

show abstract

A double-blind randomized controlled trial of patient-controlled epidural analgesia with or without a background infusion following initial spinal analgesia for labor pain

Cited by 21 publications

References 22 publications

The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis

The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis

Techniques for the maintenance of epidural labor analgesia

Effects of Local Anesthetic on the Time Between Analgesic Boluses and the Duration of Labor in Patient-Controlled Epidural Analgesia: Prospective Study of Two Ultra-Low Dose Regimens of Ropivacaine and Sufentanil

Contact Info

Product

Resources

About