Patient-controlled epidural analgesia in labour: varying bolus dose and lockout interval

Gambling, David R.; Huber, Christopher; Berkowitz, J.; Howell, P. R.; Swenerton, Jean E.; Ross, P. L. E.; Crochetière, Chantal; Pavy, T. J. G.

doi:10.1007/bf03037032

Cited by 89 publications

(41 citation statements)

References 11 publications

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“…It has the advantage of giving local anaesthetic medication via continuous infusion. When compared with continuous epidural infusion, PCEA has been shown to reduce local anaesthetic requirement [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Ahirwar

Prakash

Kushwaha

et al. 2014

JCDR

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Background: Feeling of pain is one of the most important emotional determinants which dominate the perception of females who undergo the process of labour and delivery. Patient controlled epidural labour analgesia (PCEA) is convenient and safer technique for this purpose. Very few studies compared clonidine and fentanyl with ropivacaine in labour analgesia in past. This study was undertaken to compare fentanyl and clonidine in PCEA. Aims:To compare low concentration ropivacaine with or without fentanyl or clonidine for labour analgesia and its effect on maternal and foetal safety. Settings and Design:Prospective, double blind, randomized, comparative study. Materials and Methods:Ninety primegravida in labour were divided into three groups (n=30) and patient controlled epidural labour analgesia was given to them: Initial bolus of 10ml of ropivacaine 0.125% in Group I; with fentanyl 2 µg/ml in Group II and with clonidine 1µg/kg in Group III. Subsequently each group received ropivacaine 0.125% through patient controlled epidural analgesia (PCEA) as background infusion of 5 ml/hr with lockout interval time of 10min and subsequent bolus of 5ml. Hemodynamic parameters, sensory level, motor block and pain relief were noted. Total analgesic dose of local anaesthetic and feto-maternal adverse effects were also recorded.Results: At baseline, groups were matched demographically, hemodynamically as well as for intensity of pain. There was a statistically significant decrease in hemodynamic parameters from baseline in all groups with maximum reduction in group III. A significant difference among groups in VAS was observed at zero min and from 120min till 240min intervals and lowest values were in Group III. No significant difference was observed among the groups for mode of delivery and expulsive efforts. Total analgesic dose and PCA bolus requirement was maximum in Group I and minimum in Group III and the difference was statistically significant among groups. Six (20%) patients had shivering in Group II and hypotension was recorded in only 1 (3.3%) patient of Group III.Conclusion: Ropivacaine 0.125% was effective in decreasing labour pain without any motor blockade. Clonidine 1µg/kg was superior to fentanyl 2µg/ml as an

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Section: Discussionmentioning

confidence: 99%

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Ahirwar

Prakash

Kushwaha

et al. 2014

JCDR

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“…PCEA produced similar levels of pain relief in most studies in terms of recorded Visual Analogue Scores for pain (135,137,140,(145)(146)(147)(148)(149)(150)(151)(152)(153)(154)(155). However, quality of pain relief is more than recorded VAS scores.…”

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Continuomentioning

confidence: 87%

“…Most studies can not identify a difference between both modalities. However, some indicate less outlet forceps deliveries may be required when using PCEA (148,253,154). The meta-analysis by van der Vyver et al could not confirm this however (156).…”

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Continuomentioning

confidence: 99%

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Velde

2009

Revista Española de Anestesiología y Reanimación

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Most authors would agree that central neuraxial analgesia is the best form to manage labor pain. When neuraxial analgesia is administered to the parturient in labor, different management choices must be made by theanesthetist: how will we initiate analgesia, how will analgesia be maintained, which local anesthetic will we use for neuraxial analgesia and which adjuvant drugs will we combine? The present manuscript tries to review the literature to answer these questions. INITIATION OF NEURAXIAL ANALGESIAA lmost two decades have passed since French and American trials evaluated the use of spinal opioids during labor and since European randomized trials compared conventional epidural analgesia with combined spinal epidural (CSE) analgesia (1-3). CSE analgesia has gained worldwide acceptance and is becoming increasingly popular as the method of choice for labor pain relief (4-9). Obstetric anesthetists are divided when questioned on the place of CSE in labor analgesia. Whilst some authors feel it should be the technique of choice, others reserve CSE for certain indications (10-15). Recently, Simmons et al. published a Cochrane review concluding that CSE offers little benefit as compared to conventional epidural analgesia (16). However, the authors of this meta-analysis did acknowledge that CSE produced faster analgesia, resulted in less need for rescue analgesia and was associated with less urinary retention. Apart from a slight increase in the incidence of pruritus, these beneficial effects were not associated with more complications. The three demonstrated benefits of CSE are sufficient to promotes it's use if the side-effect profile remains unaltered. Furthermore it must be stressed that this Cochrane review can be criticized. Firstly, a number of well performed studies were excluded from analysis because of uncertain reasons. Inclusion of these well performed studies into the analysis might have affected the overall conclusions. Secondly, a number of outcomes were not considered in the analysis such as one-sided analgesia, epidural catheter reliability, anesthetist intervention rate, local anesthetic consumption and the occurrence of fetal heart abnormalities. Finally, very different types of CSE were used in the various studies. They were all considered to be a generic procedure and analyzed combined.Arguably the most obvious advantage of the CSE technique is the rapid and spectacular onset of effective analgesia with minute concentrations of local anesthetics with or without adjuvant drugs (16). Consistently, effective labor analgesia is accomplished within 4-6 minutes

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“…Auch eine Studie, die sich mit dem Vergleich von früher und spä- [85][86][87][88][89][90]. Es konnte ein besseres Ergebnis der PCEA gezeigt werden, wenn eine basale epidurale Hintergrundinfusion mit Lokalanästhetika gegeben wurde [91][92][93][94][95].…”

Section: Optimaler Zeitpunkt Des Neuroaxialen Verfahrensunclassified

Aktuelle Versorgungskonzepte in der geburtshilflichen Anästhesie

Erp

Ortner

Jochberger

et al. 2017

Wien Med Wochenschr

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Patient-controlled epidural analgesia in labour: varying bolus dose and lockout interval

Abstract: This double-blind prospective study was designed to determine the best dose variables for patient-controlled epidural analgesia (PCEA)

Cited by 89 publications

References 11 publications

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Patient Controlled Epidural Labour Analgesia (PCEA): A Comparison Between Ropivacaine, Ropivacaine-Fentanyl and Ropivacaine-Clonidine

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Aktuelle Versorgungskonzepte in der geburtshilflichen Anästhesie

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