Patient-controlled epidural analgesia with and without basal infusion using ropivacaine 0.15% and fentanyl 2γ/mL for labor analgesia: a prospective comparative randomized trial

Matsota, Paraskevi; Drachtidi, Kalliopi; Batistaki, Chrysanthi; Karakosta, Agathi; Koukopoulou, Ioanna C; Koursoumi, E.; Kostopanagiotou, Georgia

doi:10.23736/s0375-9393.18.12070-0

Cited by 4 publications

(3 citation statements)

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“…Programmed intermittent epidural bolus analgesia has been compared with continuous epidural infusion and PCEA with a background infusion in prospective trials, showing superior patient satisfaction and quality of analgesia and lower motor block [5–7]. In many institutions, however, PCEA is used with no‐ or low‐volume (2–4 ml) continuous background infusion [8–10, 13, 14]. A meta‐analysis concluded that PCEA alone and PCEA with a background infusion resulted in similar outcomes [8], although this was confounded by large heterogeneity in background infusion rates and PCEA bolus volumes.…”

Section: Discussionmentioning

confidence: 99%

Programmed intermittent epidural bolus vs. patient‐controlled epidural analgesia for maintenance of labour analgesia: a two‐centre, double‐blind, randomised study†

et al. 2020

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Summary The programmed intermittent epidural bolus technique has shown superiority to continuous epidural infusion techniques, with or without patient‐controlled epidural analgesia for pain relief, reduced motor block and patient satisfaction. Many institutions still use patient‐controlled epidural analgesia without a background infusion, and a comparative study between programmed intermittent epidural bolus and patient‐controlled epidural analgesia without a background infusion has not yet been performed. We performed a randomised, two‐centre, double‐blind, controlled trial of these two techniques. The primary outcome was the incidence of breakthrough pain requiring a top‐up dose by an anaesthetist. Secondary outcomes included: motor block; pain scores; patient satisfaction; local anaesthetic consumption; and obstetric and neonatal outcomes. We recruited 130 nulliparous women who received initial spinal analgesia, and then epidural analgesia was initiated and maintained with either programmed intermittent epidural bolus or patient‐controlled epidural analgesia using ropivacaine 0.12% with sufentanil 0.75 µg·ml‐1. The programmed intermittent epidural bolus group had a programmed bolus of 10 ml every hour, with on‐demand patient‐controlled epidural analgesia boluses of 5 ml with a 20 min lockout, and the patient‐controlled epidural analgesia group had a 5 ml bolus with a 12 min lockout interval; the potential maximum volume per hour was the same in both groups. The patients in the programmed intermittent epidural bolus group had less frequent breakthrough pain compared with the patient‐controlled epidural analgesia group, 7 (10.9%) vs. 38 (62.3%; p < 0.0001), respectively. There was a significant difference in motor block (modified Bromage score ≤ 4) frequency between groups, programmed intermittent epidural bolus group 1 (1.6%) vs. patient‐controlled epidural analgesia group 8 (13.1%); p = 0.015. The programmed intermittent epidural bolus group had greater local anaesthetic consumption with fewer patient‐controlled epidural analgesia boluses. Patient satisfaction scores and obstetric or neonatal outcomes were not different between groups. In conclusion, we found that a programmed intermittent epidural bolus technique using 10 ml programmed boluses and 5 ml patient‐controlled epidural analgesia boluses was superior to a patient‐controlled epidural analgesia technique using 5 ml boluses and no background infusion.

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Section: Discussionmentioning

confidence: 99%

Programmed intermittent epidural bolus vs. patient‐controlled epidural analgesia for maintenance of labour analgesia: a two‐centre, double‐blind, randomised study†

et al. 2020

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“…La mediana del dolor previo a la inserción del catéter fue severo, hallazgo similar a los obtenidos en la literatura (9,(13)(14)(15). Attanasio consideró que la inserción del catéter en estadios avanzados se relaciona con pobre control del dolor.…”

Section: Discussionunclassified

“…Sin embargo, en nuestro caso se instauró la modalidad de PCA en fase latente del trabajo de parto en la mayoría de las pacientes. Nuestros resultados evidencian un óptimo control del dolor a los 15 minutos posterior a la inserción, similar los hallazgos obtenidos por Chepujnoska y Matsota (13,14) en los que, aunque el dolor fue medido en intervalos diferentes, se reportan cifras de dolor EVN 1-2/10 equivalente a dolor leve posterior al uso de PCA.…”

Section: Discussionunclassified

Impacto del uso de analgesia peridural controlada por la paciente en la disminución del dolor durante el trabajo de parto en un hospital del suroccidente colombiano

Ramírez¹,

Arango²,

Santacruz³

et al. 2022

Rev. Soc. Esp. Dolor.

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Introducción: La analgesia epidural controlada por la paciente (PCA) provee flexibilidad al permitir acomodar la analgesia de acuerdo con las necesidades crecientes del dolor a medida que progresa el trabajo de parto (TP). El propósito de este estudio es objetivar el impacto en el alivio del dolor y satisfacción materna en pacientes en TP con analgesia PCA.Pacientes y métodos: Estudio descriptivo prospectivo realizado en el segundo semestre del 2020. Se incluyeron gestantes con embarazo único con escala verbal numérica (EVN) mayor a 3 y se excluyeron a las pacientes con contraindicaciones para inserción de catéter.Posterior a la inserción, se valoró el dolor y se entregó un cuestionario para calificar el dolor a los 15 min y en el expulsivo.Resultados: La población estaba constituida por mujeres jóvenes, el 72 % con embarazo a término. El catéter peridural se insertó en la fase latente del trabajo de parto en el 53,4 % de los casos. Al momento de la inserción del catéter, la mediana de dolor fue de 8 (6-10), a los 15 minutos 2 (0-4) y en el expulsivo 5 (3-8). El 75 % de las maternas refirieron estar muy satisfechas y el 19 % satisfechas; un 3 % indicaron estar poco satisfechas y el 1 % restante, insatisfechas. La prevalencia náusea y vómito fue del 16 % y 15 %, respectivamente.Conclusiones: PCA c omo estrategia analgésica durante el trabajo de parto a través de bolos intermitentes a demanda logró un adecuado control del dolor en los primeros minutos posterior a la inserción sin un control óptimo durante el expulsivo, sin embargo, se obtuvo una satisfacción materna global alta.Palabras clave: Analgesia controlada por el paciente (PCA), analgesia obstétrica, analgesia epidural, satisfacción del paciente.

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Comparison of different delivery modalities of epidural analgesia and intravenous analgesia in labour: a systematic review and network meta-analysis

Wydall

Zolger

Owolabi

et al. 2023

Can J Anesth/J Can Anesth

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Patient-controlled epidural analgesia with and without basal infusion using ropivacaine 0.15% and fentanyl 2γ/mL for labor analgesia: a prospective comparative randomized trial

Cited by 4 publications

References 0 publications

Programmed intermittent epidural bolus vs. patient‐controlled epidural analgesia for maintenance of labour analgesia: a two‐centre, double‐blind, randomised study†

Programmed intermittent epidural bolus vs. patient‐controlled epidural analgesia for maintenance of labour analgesia: a two‐centre, double‐blind, randomised study†

Impacto del uso de analgesia peridural controlada por la paciente en la disminución del dolor durante el trabajo de parto en un hospital del suroccidente colombiano

Comparison of different delivery modalities of epidural analgesia and intravenous analgesia in labour: a systematic review and network meta-analysis

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