Document Detail


A randomized comparison of automated intermittent mandatory boluses with a basal infusion in combination with patient-controlled epidural analgesia for labor and delivery.
MedLine Citation:
PMID:  20832282     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
S Leo; C E Ocampo; Y Lim; A T Sia
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2010-09-15
Journal Detail:
Title:  International journal of obstetric anesthesia     Volume:  19     ISSN:  1532-3374     ISO Abbreviation:  Int J Obstet Anesth     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-27     Completed Date:  2011-01-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9200430     Medline TA:  Int J Obstet Anesth     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  357-64     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Ltd. All rights reserved.
Affiliation:
Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.
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MeSH Terms
Descriptor/Qualifier:
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:
0/Anesthetics, Local

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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