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OBSTETRIC ANESTHESIA

Patient-Controlled Epidural Analgesia During Labor: The Effects of the Increase in Bolus and Lockout Interval

Jean-Marc Bernard, MD, PhD^*, Daniel Le Roux, MD^*, Louis Vizquel, MD^*, Alexandre Barthe, MD^*, Jean-Marie Gonnet, MD, Alain Aldebert, MD, Reda M. Benani, MD^*, Christian Fossat, MD, and Jacques Frouin, MD^*

*Département d’Anesthésie-Réanimation and Clinique Gynécologique et Obstétricale, Polyclinique Jean-Villar, Bruges-Bordeaux, France

Address correspondence and reprint requests to Dr. Jean-Marc Bernard, Département d’Anesthésie-Réanimation, Polyclinique Jean-Villar, BP 61, F-33520 Bruges-Bordeaux, France.

Most studies use a bolus size of <6 mL of 0.125% bu- pivacaine for patient-controlled epidural analgesia (PCEA) during labor. In this double-blinded, randomized study, we compared the efficacy of a larger bolus injected via a PCEA pump to a conventional PCEA setting. By using a combination of 0.125% bupivacaine with 1:800,000 epinephrine and 0.625 µg/mL sufentanil, the first PCEA setting was typical (4 mL/8 min), whereas the other combined a 12-mL bolus dose and a 25-min lockout interval, i.e., similar maximal hourly dose. Rescue analgesia was provided with 6 mL of 0.25% bupivacaine. Patient satisfaction and pain were scored on verbal and visual analog scales. Data were analyzed from 103 parturients in the 12-mL/25-min group and 100 in the 4-mL/8-min group. In the 12-mL/25-min group, the median pain score on a 0- to 10-cm visual analog scale was lower at 6-cm cervical dilation (1 [range = 0–8] vs 3 [0–8]) and at delivery (1 [0–10] vs 2 [0–10]). Satisfaction was also better (70% vs 38% "excellent" opinions, at 6-cm cervical dilation). Use of the pump (ratio of successful and total demands) was high and similar in both groups. Rescue analgesia was comparable. Doses of analgesics were greater in the 12-mL/25-min group (hourly bupivacaine dose = 13.9 ± 5.3 [mean± SD] vs 9.4 ± 4.1 mg). No differences were noted between groups for the severity of hypotension, ephedrine requirement, outcome of the delivery, and Apgar scores.

Implications: A patient-controlled epidural analgesia setting that allows a parturient to receive an increased analgesic dose improves satisfaction with patient-controlled epidural analgesia during labor.

This article has been cited by other articles:

				J.-M. Bernard, D. Le Roux, and J. Frouin Ropivacaine and Fentanyl Concentrations in Patient-Controlled Epidural Analgesia During Labor: A Volume-Range Study Anesth. Analg., December 1, 2003; 97(6): 1800 - 1807. [Abstract] [Full Text] [PDF]

				E. Boselli, R. Debon, F. Duflo, B. Bryssine, B. Allaouchiche, and D. Chassard Ropivacaine 0.15% Plus Sufentanil 0.5 {micro}g/mL and Ropivacaine 0.10% Plus Sufentanil 0.5 {micro}g/mL Are Equivalent for Patient-Controlled Epidural Analgesia During Labor Anesth. Analg., April 1, 2003; 96(4): 1173 - 1177. [Abstract] [Full Text] [PDF]

				J.-M. Bernard, D. Le Roux, A. Barthe, O. Jourdain, L. Vizquel, and C. Michel The Dose-Range Effects of Sufentanil Added to 0.125% Bupivacaine on the Quality of Patient-Controlled Epidural Analgesia During Labor Anesth. Analg., January 1, 2001; 92(1): 184 - 188. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999