| A randomized comparison of automated intermittent mandatory boluses with a basal infusion in combination with patient-controlled epidural analgesia for labor and delivery. | |
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MedLine Citation:
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PMID: 20832282 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Automated mandatory boluses (AMB), when used in place of a continuous basal infusion, have been shown to reduce overall local anesthetic consumption without compromising analgesic efficacy in patient-controlled epidural analgesia (PCEA). We hypothesized that our PCEA+AMB regimen could result in a reduction of breakthrough pain requiring epidural supplementation in comparison with PCEA with a basal infusion (PCEA+BI). METHODS: We recruited sixty-two healthy ASA I nulliparous parturients in early labor. The parturients were randomized to receive 0.1% ropivacaine+fentanyl 2 μg/mL either via PCEA+BI (PCEA with basal continuous infusion of 5mL/h) or PCEA+AMB (PCEA with AMB of 5 mL every hour instead of a basal infusion) immediately following successful induction of combined spinal-epidural (CSE) analgesia. Block characteristics, incidence of breakthrough pain requiring epidural supplementation, side effects, obstetric outcomes, Apgar scores and overall maternal satisfaction with analgesia were noted. RESULTS: The time-weighted hourly consumption of ropivacaine (PCEA and clinician supplementation for breakthrough pain) was significantly lower in the PCEA+AMB group (mean=7.6 mL, SD 3.2) compared to the PCEA+BI group (mean=9.3 mL, SD 2.5; P<0.001). The mean time to first PCEA self-bolus following CSE was significantly longer in the PCEA+AMB group compared to the PCEA+BI group (268 min vs. 104 min; P<0.001). Parturients in Group PCEA+AMB also gave higher satisfaction scores. The incidence of breakthrough pain was similar in both groups. CONCLUSION: PCEA+AMB, when compared to PCEA+BI, confers greater patient satisfaction and a longer duration of effective analgesia after CSE despite reduced analgesic consumption. |
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Authors:
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S Leo; C E Ocampo; Y Lim; A T Sia |
Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial Date: 2010-09-15 |
Journal Detail:
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Title: International journal of obstetric anesthesia Volume: 19 ISSN: 1532-3374 ISO Abbreviation: Int J Obstet Anesth Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-27 Completed Date: 2011-01-21 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9200430 Medline TA: Int J Obstet Anesth Country: Netherlands |
Other Details:
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Languages: eng Pagination: 357-64 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Elsevier Ltd. All rights reserved. |
Affiliation:
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Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Analgesia, Epidural / adverse effects, methods* Analgesia, Obstetrical / adverse effects, methods* Analgesia, Patient-Controlled / adverse effects, methods* Anesthesia, Spinal / adverse effects, methods* Anesthetics, Local / administration & dosage Automation Blood Pressure / drug effects Delivery, Obstetric* Female Heart Rate / drug effects Heart Rate, Fetal / drug effects Humans Infant, Newborn Infusion Pumps Kaplan-Meier Estimate Labor, Obstetric* Pain Measurement Pregnancy Pregnancy Outcome Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anesthetics, Local |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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