Background Infusion Is Not Beneficial during Labor Patient-controlled Analgesia with 0.1% Ropivacaine plus 0.5 μg/ml Sufentanil

Abstract

The results of this study suggest that the use of a background infusion with PCEA during labor leads to a greater consumption of anesthetic solution without improving comfort and satisfaction of parturients. Moreover, not using a background infusion does not provide an increased incidence of supplemental boluses (which might cause problems in a busy unit) and allows for a substantial reduction in the cost of analgesia.

Side effects of the addition of clonidine 75 μg or sufentanil 5 μg to 0.2% ropivacaine for labour epidural analgesia

“…However, the effect of a basal rate on local anaesthetic consumption and the incidence of motor block remains controversial. [25][26][27][28] No significant difference between groups was observed in FHR abnormalities related to hypotension, although this study was underpowered for this outcome. When hypotension is immediately corrected with full left lateral position, ephedrine administration and fluid loading, it does not increase the incidence of caesarean section or affect the Apgar score.…”

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

“…15 Boselli et al showed that a demand-only PCEA could produce similar labor analgesia while reducing the hourly requirements of ropivacaine when compared with PCEA+CBI. 12 However, two recent studies have shown that PCEA+CBI may result in better analgesia and a reduced number of interventions by the medical staff than with demand-only PCEA. 13,14 In these studies, the bolus volume of anesthetic was similar to that of Boselli et al Values are mean ± SD or numbers; Abbreviations as in text; * P < 0.05 compared to Group PCEA.…”

“…12 This suggests that CBI is less advantageous when the lockout time is short. It is possible that longer lockout times with no background infusion or small bolus doses may not allow the agents to disperse adequately; several investigations have indicated that the dose and volume of the bolus injection is important for effective PCEA labor analgesia.…”

“…However, an ideal protocol for delivery of PCEA has not been agreed upon, 8,9 with the effectiveness and advisability of a continuous background infusion (CBI) being a key issue. Some investigators have questioned the advantages of a CBI, [10][11][12] suggesting that omitting the infusion would reduce the overall dose of analgesic agents used during labor. By contrast, other investigators have demonstrated improved analgesia with a CBI.…”

Aktuelle Versorgungskonzepte in der geburtshilflichen Anästhesie

“…Es konnte ein besseres Ergebnis der PCEA gezeigt werden, wenn eine basale epidurale Hintergrundinfusion mit Lokalanästhetika gegeben wurde [91][92][93][94][95]. In Bezug auf motorische Blockade und Art der Entbindung konnten keine eindeutigen Ergebnisse in der Literatur gefunden werden [91][92][93][94][95][96]. Ein neuer Therapieansatz ist die PIEB ("Programmed Intermittent Epidural Bolus", PIEB) und wird als Weiterentwicklung der PCEA gesehen.…”