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The effects of epidural bupivacaine administration for postoperative pain after major abdominal surgery. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.574416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sng BL, Sia ATH, Lim Y, Woo D, Ocampo C. Comparison of Computer-integrated Patient-controlled Epidural Analgesia and Patient-controlled Epidural Analgesia with a Basal Infusion for Labour and Delivery. Anaesth Intensive Care 2019; 37:46-53. [DOI: 10.1177/0310057x0903700119] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- B. L. Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - A. T. H. Sia
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - Y. Lim
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - D. Woo
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - C. Ocampo
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
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Abstract
Patient-controlled analgesia (PCA) is a delivery system with which patients self-administer predetermined doses of analgesic medication to relieve their pain. Since its introduction in the early 1980s, the daily management of postoperative pain has been extensively optimised. The use of PCA in hospitals has been increasing because of its proven advantages over conventional intramuscular injections. These include improved pain relief, greater patient satisfaction, less sedation and fewer postoperative complications. All PCA modes contain the following variables: initial loading dose, demand dose, lockout interval, background infusion rate and 1-hour or 4-hour limits. Morphine is the most studied and most commonly used intravenous drug for PCA. In spite of the fact that it is the 'first choice' for PCA, other opioids have been successfully used for this option. The most observed adverse effects of opioid-based PCA are nausea and vomiting, pruritus, respiratory depression, sedation, confusion and urinary retention. Although intravenous PCA is the most studied route of PCA, alternative routes have extensively been described in the literature. PCA by means of peridural catheters and peripheral nerve catheters are the most studied. Recently, transdermal PCA has been described. The use of peripheral or neuraxial nerve blocks is recommended to avoid the so called opioid tolerance observed with the intravenous administration of opioids. Numerous studies have shown the superiority of epidural PCA to intravenous PCA. The beneficial postoperative effects of epidural analgesia are more apparent for high-risk patients or those undergoing higher risk procedures. PCA with peripheral nerve catheters results in increased postoperative analgesia and satisfaction for surgery on upper and lower extremities. Serious complications occur rarely with these catheters. With the introduction of an Acute Pain Service, management of postoperative pain can be improved. This will also help to minimise adverse effects related to PCA and to avoid lethal mishaps.
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Affiliation(s)
- Mona Momeni
- Department of Anaesthesiology, University Hospital St Luc, Brussels, Belgium.
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Affiliation(s)
- Richard M Smiley
- Columbia University Medical Center, Department of Anesthesiology, New York, New York 10032, USA.
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Carvalho B, Wang P, Cohen SE. A survey of labor patient-controlled epidural anesthesia practice in California hospitals. Int J Obstet Anesth 2006; 15:217-22. [PMID: 16798447 DOI: 10.1016/j.ijoa.2006.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 03/13/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for labor analgesia including fewer physician interventions, improved analgesia and satisfaction, and reduced local anesthetic doses. However, anesthesiologists have been slow to adopt this technique, first described in 1988. No previous studies have evaluated specific labor patient-controlled epidural analgesia practices in the United States. The aim of this study was to determine labor epidural and patient-controlled epidural analgesia practices among California hospitals. METHODS Following institutional review board exemption approval, an online survey was created using freeonlinesurveys.com. An anonymous survey was sent via e-mail to 230 California Society of Anesthesiologists' members chosen at random to represent their hospitals' labor analgesia practices. RESULTS We received 133 replies from the 230 survey requests sent, a 58% response rate. The median labor epidural rate among the hospitals involved was 65% (range 0-95%). Overall, only 25% of California hospitals use patient-controlled epidural analgesia for analgesia in labor, with greater use among hospitals with dedicated obstetric anesthesia coverage and larger numbers of deliveries. Reasons given for not using patient-controlled epidural analgesia include cost, clinician preference, safety concerns and the inconvenience of change. CONCLUSIONS Despite the potential advantages of patient-controlled epidural analgesia over continuous epidural infusions for labor analgesia, patient-controlled epidural analgesia has not been widely adopted in California hospitals. Education regarding this technique is needed to encourage its increased use.
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Affiliation(s)
- B Carvalho
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA.
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6
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Abstract
OBJECTIVES Update on patient controlled epidural analgesia for labour. STUDY DESIGN Literature review of the recent data on local anaesthetics, additional analgesics and of publications on the various protocols used. DATA COLLECTION Pubmed database was checked with the following key words: PCEA, labour, opioids, clonidine. The abstracts of the ASA meetings from 2000 to 2005 were also examined. RESULTS Patient controlled epidural analgesia (PCEA) is the method of choice for optimal labour pain management. The advantages of this technique are numerous. Some of them are established: consistent reduction in overall local anathetic requirement, less motor blockade, safety of the technique and team workload reduction. A better adequacy with the analgesic requirements and an increase in overall patient satisfaction are frequently retrieved, provided that the choice of the analgesics and the PCEA parameters are adequately chosen. CONCLUSION The use of PCEA improves the quality of analgesic management offered to the parturients who are more and more willing to have a "more natural" childbirth. The PCEA gives them more autonomy and, in fine, enables them to better enjoy this unique event. The main barrier to a more widespread diffusion of PCEA in many institutions remains the financial issue, although a well-selected device and low cost disposables allow a reduction of indirect costs by decreasing care giver workload.
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Affiliation(s)
- E Lopard
- Service d'Anesthésie, Hôpital Notre-Dame-de-Bon-Secours, 66, 68, Rue des Plantes, 75014 Paris, France.
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Carvalho B, Cohen SE, Giarrusso K, Durbin M, Riley ET, Lipman S. “Ultra-light” patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload. Int J Obstet Anesth 2005; 14:223-9. [PMID: 15935646 DOI: 10.1016/j.ijoa.2005.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 02/01/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for maintenance of labor analgesia. Some of these benefits may depend on the PCEA settings. This study evaluated several regimens for "ultra-light" (0.125%) PCEA with basal continuous infusion (CI) in labor with goals of minimizing physician interventions while providing good analgesia. METHODS Two hundred and twenty ASA I-II women receiving epidural analgesia during active labor (cervical dilation <5 cm) were randomly assigned in a double-blind manner to four treatment groups (n=30 in each). Analgesia was maintained with a PCEA/CI pump using bupivacaine 0.0625% + sufentanil 0.35 microg/mL. PCEA settings were: group A: CI 10 mL/h, PCEA bolus 6 mL, 8-min lockout; group B: CI 10 mL/h, PCEA bolus 12 mL, 16-min lockout; group C: CI 15 mL/h, PCEA bolus 6 mL, 8-min lockout; group D: CI 15 mL/h, PCEA bolus 12 mL, 16-min lockout. RESULTS In groups A, B, C and D, 76, 77, 75 and 85% of parturients respectively, required no physician rescue boluses. Pain scores were low and maternal satisfaction was high in all groups, with minimal differences among them. Spontaneous vaginal delivery occurred in 78% of patients overall, instrumental (forceps or vacuum) delivery in 10% and cesarean section in 12%. CONCLUSIONS These ultra-light PCEA regimens provided excellent analgesia with minimal physician workload and a high spontaneous delivery rate. Use of moderate to high-volume, ultra-light PCEA/CI techniques should facilitate provision of labor analgesia in busy obstetric units.
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Affiliation(s)
- B Carvalho
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA.
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8
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Paech M. Patient-controlled epidural analgesia for labor and delivery: a novelty or a practical method? ACTA ACUST UNITED AC 2003. [DOI: 10.1053/j.trap.2003.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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9
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Abstract
In maternity units in which central neuraxial techniques are frequently used, newer methods of epidural drug delivery (continuous infusion, patient-controlled) are well established and combined spinal-epidural analgesia is commonly used. Continuous spinal analgesia has reemerged as a useful approach after accidental dural puncture. Lumbar sympathetic block has been revisited and the safety of paracervical nerve block improved. The analgesic properties of systemic opioid in labor are poor, but PCIA at least has psychological benefits and allows rapid drug titration. PCIA is again under investigation because of the potent antinociceptive effects of the short-acting mu-opioid agonist, remifentanil. The premixing of nitrous oxide and a subanesthetic concentration of volatile anesthetic for patient-controlled administration has been tested under control of midwifery staff and without direct medical supervision.
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Affiliation(s)
- Michael Paech
- Department of Medicine and Pharmacology, University of Western Australia, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women and Royal Perth Hospitals, Western Australia, Australia.
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Le Guen H, Roy D, Branger B, Ecoffey C. Comparison of fentanyl and sufentanil in combination with bupivacaine for patient-controlled epidural analgesia during labor. J Clin Anesth 2001; 13:98-102. [PMID: 11331168 DOI: 10.1016/s0952-8180(01)00221-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVES To compare the efficacy of fentanyl plus bupivacaine with sufentanil plus bupivacaine for treatment of pain during labor and delivery using patient-controlled epidural analgesia (PCEA). DESIGN Prospective, double-blind, clinical investigation. SETTINGS University-affiliated hospital. PATIENTS 226 ASA physical status I and II laboring patients. INTERVENTIONS Patients were randomized to receive 0.125% bupivacaine with fentanyl (2 micro g.ml(-1)) or 0.125% bupivacaine with sufentanil (0.25 micro g.ml(-1)) through PCEA. MEASUREMENTS Maternal analgesia assessed by visual analog scale was recorded before epidural block, 1 and 3 hours after epidural block, at full cervical dilation, and at delivery. Motor blockade assessed by Bromage scale was recorded at delivery. MAIN RESULTS Nine patients in group fentanyl, and 11 in group sufentanil were excluded from the study. Overall analgesia was good and no difference was observed between the two groups. Total boluses of 4 mL bupivacaine-opioid administered and the number of supplementary top-up injections of 5 mL 0.25% bupivacaine were similar in both groups. In group sufentanil, motor blockade and pruritus were significantly lower than in group fentanyl. Nausea was not recorded in any patients. Mode of delivery was similar in both groups, i.e., cesarean section, vacuum or forceps, or spontaneous vaginal delivery. No difference was observed in Apgar scores. CONCLUSIONS Sufentanil is preferable to fentanyl during bupivacaine PCEA as there is less incidence of motor blockade and pruritus.
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Affiliation(s)
- H Le Guen
- Department of Anesthesiology and Surgical Intensive Care 2, Université de Rennes I, Rennes, France
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11
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Ruban P, Sia AT, Chong JL. The effect of adding fentanyl to ropivacaine 0.125% on patient-controlled epidural analgesia during labour. Anaesth Intensive Care 2000; 28:517-21. [PMID: 11094666 DOI: 10.1177/0310057x0002800505] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of patient-controlled epidural analgesia (PCEA) for labour analgesia is rapidly gaining acceptance. However, the ideal PCEA solution and PCEA program remains uncertain. We studied the effect of adding fentanyl 2 micrograms/ml on demand-only PCEA using ropivacaine 0.125% for labour analgesia. With the approval of the Hospital Ethics Committee, this prospective randomized controlled trial was conducted on 36 nulliparous ASA 1/2 parturients in early, but established, labour. Upon written consent, epidural analgesia was started with 10 ml ropivacaine 0.2%. The parturients subsequently were randomized to receive either ropivacaine 0.125% (n = 18) or ropivacaine 0.125% with fentanyl 2 micrograms/ml (n = 18). The PCEA was programmed to a demand-only mode with bolus of 5 ml, lockout time of 10 minutes and maximum volume per hour of 20 ml. The degree of pain relief was similar in both groups. However, the total amount of ropivacaine used per hour was lower in the group that received fentanyl (median 7.1 vs 10.1 mg, P < 0.05). This was not associated with a decrease in motor blockade or a decrease in instrumental deliveries. The ratio of successful PCEA demand to total number of demands, the satisfaction score and the maternal-fetal outcome were similar in both groups. In conclusion, the addition of fentanyl had a dose-sparing effect on the requirement of ropivacaine. This PCEA regimen produced a low incidence of motor block, good labour pain relief and excellent patient satisfaction.
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Affiliation(s)
- P Ruban
- Department of Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
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12
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Abstract
The discovery of opioid receptors and the subsequent development of the technique of epidural and intrathecal opioid administration are undoubtedly two of the most significant advances in pain management in recent decades. The use of spinal opioids is widespread and increasing. The technique is used widely to treat intraoperative, postoperative, traumatic, obstetric, chronic, and cancer pain. Newer developments include the increasing use of combined local anesthetics and opioids or nonopioids and also PCEA, particularly in the obstetric population. Meta-analysis of controlled trials has demonstrated improved pulmonary outcome in patients receiving epidural postoperative analgesia. Although rare, respiratory depression continues to be a major problem of the technique. None of the currently available opioids is completely safe; however, extensive international experience has shown that patients receiving spinal opioids for postoperative analgesia can be safely nursed on regular wards, provided that trained personnel and appropriate guidelines are available. The importance of a good acute pain service to provide the safe and effective use of spinal opioids cannot be overemphasized.
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MESH Headings
- Analgesia, Epidural
- Analgesia, Patient-Controlled
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/adverse effects
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/adverse effects
- Drug Therapy, Combination
- Humans
- Injections, Spinal
- Pain, Postoperative/prevention & control
- Respiration/drug effects
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Affiliation(s)
- N Rawal
- Department of Anesthesiology and Intensive Care, Orebro Medical Center Hospital, Sweden.
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13
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Paech M. New epidural techniques for labour analgesia: patient-controlled epidural analgesia and combined spinal-epidural analgesia. BAILLIERE'S CLINICAL OBSTETRICS AND GYNAECOLOGY 1998; 12:377-95. [PMID: 10023427 DOI: 10.1016/s0950-3552(98)80073-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Epidural analgesia in labour aims to provide high-quality pain relief of rapid onset and prolonged duration, while minimizing both maternal side-effects, particularly impairment of mobility, and impact on the fetus or on the outcome of labour. In conjunction with pharmacological research on spinal analgesics (local anaesthetics, opioids and other drug classes), refinement of new or established drug delivery techniques has allowed progress toward more reliable and improved pain relief at all stages of labour and childbirth, reduced individual drug doses with reduction of unwanted effects and greater safety and enhancement of maternal satisfaction. Patient-controlled epidural analgesia in labour has been in use for almost a decade, although is only now at a stage where its role is well defined and utility can be increased. Combined spinal-epidural analgesia is a more recent refinement which appears to be extremely promising but awaits further investigation.
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Affiliation(s)
- M Paech
- Department of Anaesthesia, King Edward Memorial Hospital for Women, Western Australia, Australia
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14
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Obstetric anesthesia. Acta Anaesthesiol Scand 1997. [DOI: 10.1111/j.1399-6576.1997.tb04898.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Smith AJ, Haynes TK, Roberts DE, Harmer M. A comparison of opioid solutions for patient-controlled epidural analgesia. Anaesthesia 1996; 51:1013-7. [PMID: 8943590 DOI: 10.1111/j.1365-2044.1996.tb14993.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sixty patients took part in a randomised, double-blind study to compare the analgesic and side effects of three opioid-containing solutions for patient-controlled epidural analgesia following abdominal surgery. Patients in group 1 received a solution containing bupivacaine 0.125% with fentanyl 10 micrograms.ml-1, group 2 bupivacaine 0.125% with diamorphine 125 micrograms.ml-1, group 3 pethidine 2.5 mg.ml-1. All groups received 4 ml.h-1 background infusion and 3 ml boluses every 20 min if necessary. There were no significant differences between the groups in visual analogue scale pain scores (p = 0.537) or volumes of solution used at 24 h (p = 0.351) or 48 h (p = 0.105). Motor block was significantly higher in group 2 (p < 0.004) and pruritus occurred significantly less in group 3 (p < 0.05). We conclude that these three solutions produce equivalent analgesia but that pethidine 2.5 mg.ml-1 may be associated with fewer side effects.
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Affiliation(s)
- A J Smith
- Department of Anaesthetics, University Hospital of Wales, Health Park, Cardiff
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16
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Abstract
PCEA is an attractive concept with special benefits in the obstetric population. It provides a safe and valuable alternative to other approaches to labour analgesia, with demonstrable advantages when used appropriately by motivated women. It also appears to be useful for management of pain after caesarean section. It may occasionally be of benefit in other acute and chronic pain settings in the obstetric population. Despite promising initial results, the full potential of PCEA remains to be explored, and this may be encouraged by ongoing developments in PCA pump technology. Comprehensive comparative studies and large prospective clinical series, further defining its role and safety in various settings, are awaited.
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Affiliation(s)
- M J Paech
- Department of Anaesthesia, King Edward Memorial Hospital for Women, Perth, Western Australia
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17
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Gambling DR. Epidural infusions in labour should be abandoned in favour of patient-controlled epidural analgesia. Int J Obstet Anesth 1996; 5:59-61. [PMID: 15321385 DOI: 10.1016/s0959-289x(96)80077-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- D R Gambling
- Department of Anesthesiology, University of California, San Diego, La Jolla 92093-0801, USA
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18
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Paech MJ, Pavy TJ, Sims C, Westmore MD, Storey JM, White C. Clinical experience with patient-controlled and staff-administered intermittent bolus epidural analgesia in labour. Anaesth Intensive Care 1995; 23:459-63. [PMID: 7485937 DOI: 10.1177/0310057x9502300408] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A prospective, randomized study was performed to detail clinical experience with both patient-controlled epidural analgesia (PCEA) and midwife-administered intermittent bolus (IB) epidural analgesia during labour, under the conditions pertaining in a busy obstetric delivery unit. Both methods used 0.125% bupivacaine plus fentanyl, and similar rescue supplementation, although management decisions related to epidural analgesia were made principally by attending midwives. One hundred and ninety-eight women were recruited and data analysed from 167 (PCEA n = 82, IB n = 85). The groups were demographically similar. Median hourly pain scores, ratings of analgesia and satisfaction did not differ. Maximum pain scores were significantly higher in those receiving IB epidural analgesia (P < 0.05). The PCEA group had a significantly higher rate of supplementation and bupivacaine use (P < 0.01), and a longer duration of the second stage of labour (P < 0.03). The relative risk of instrumental delivery with PCEA versus the IB method was 1.57 (CI 1.07-2.38). Experience within our unit with PCEA is contrasted with that of IB epidural analgesia, the method most commonly used; and with that of controlled trials comparing these two methods.
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Affiliation(s)
- M J Paech
- Department of Anaesthesia, King Edward Memorial Hospital for Women, Subiaco, W.A
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Vandermeulen EP, Van Aken H, Vertommen JD. Labor pain relief using bupivacaine and sufentanil: patient controlled epidural analgesia versus intermittent injections. Eur J Obstet Gynecol Reprod Biol 1995; 59 Suppl:S47-54. [PMID: 7556823 DOI: 10.1016/0028-2243(95)02063-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To determine whether the use of patient-controlled epidural analgesia (PCEA) versus intermittent injections (CIT) resulted in local anesthetic dose reduction. STUDY DESIGN PCEA and CIT using a mixture of 0.125% bupivacaine with sufentanil 1 or 0.75 microgram/ml were compared in 60 and 195 parturients, respectively. Assessments included pain scores, local anesthetic consumption, degree of motor blockade, type of delivery and neonatal outcome. Statistical analysis was done using Student's t test and Chi-squares. RESULTS PCEA and CIT provided effective analgesia during labor and delivery. A higher dose of opioid significantly reduced the use of local anesthetic solution in PCEA-patients. There was no difference in motor blockade, type of delivery and neonatal outcome. CONCLUSION Patient-controlled epidural analgesia is an effective, safe and acceptable alternative to conventional intermittent epidural injections for pain relief during labor and delivery.
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MESH Headings
- Adult
- Analgesia, Epidural/standards
- Analgesia, Obstetrical/standards
- Analgesia, Patient-Controlled/standards
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/standards
- Analgesics, Opioid/therapeutic use
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/standards
- Anesthetics, Local/therapeutic use
- Bupivacaine/administration & dosage
- Bupivacaine/standards
- Bupivacaine/therapeutic use
- Drug Combinations
- Epinephrine/administration & dosage
- Epinephrine/standards
- Epinephrine/therapeutic use
- Female
- Humans
- Injections/standards
- Labor, Obstetric/drug effects
- Labor, Obstetric/physiology
- Pain/drug therapy
- Pain/physiopathology
- Pregnancy
- Pregnancy Outcome
- Sufentanil/administration & dosage
- Sufentanil/standards
- Sufentanil/therapeutic use
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Affiliation(s)
- E P Vandermeulen
- Department of Anesthesiology, Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
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20
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Gambling DR, White PF. Role of patient-controlled epidural analgesia in obstetrics. Eur J Obstet Gynecol Reprod Biol 1995; 59 Suppl:S39-46. [PMID: 7556822 DOI: 10.1016/0028-2243(95)02062-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- D R Gambling
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA
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21
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Benhamou D. Epidural analgesia during labor: continuous infusion or patient-controlled administration? Eur J Obstet Gynecol Reprod Biol 1995; 59 Suppl:S55-6. [PMID: 7556824 DOI: 10.1016/0028-2243(95)02064-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patient-controlled epidural analgesia (PCEA) has several advantages over continuous epidural infusion of bupivacaine during labor: it produces a good analgesia with a limited sensory spread; generally, less bupivacaine is administered and maternal satisfaction with pain control is increased. However, the quality of analgesia is similar to that obtained with other forms of epidural administration. Moreover, PCEA is only a particular form of epidural and, as such, has the same safety requirements. PCEA does not appear to reduce the workload of the anesthetic team. The cost of the PCA pump will need to be included in future evaluation of the cost/benefit ratio.
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Affiliation(s)
- D Benhamou
- Département d'Anesthésie-Réanimation Hôpital Antoine Béclère, Clamart, France
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22
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Abstract
Properly administered epidural analgesia provides adequate pain relief during labor and delivery, shortens the first stage of labor, avoids adverse effects of narcotics, hypnotics, or inhalation drugs and it could be used as anesthesia in case a cesarean section is required. Epidural analgesia should be provided to all patients who need and ask for it with an exception of contraindications such as coagulation disorders, suspected infection or gross anatomic abnormality. The technique must be carried out with care if serious life-threatening complications, such as intravenous or intrathecal injection of local anesthetic, are to be avoided. The aim of many recent investigations has been to reduce the total dose of local anesthetic used. Supplementation of an opioid (mainly fentanyl) and introduction of the patient controlled epidural pump may not only serve this goal, but also reduce the demands on the time of obstetric anesthetists. We conclude that properly and skillfully administered epidural is the best form of pain relief during labor and delivery and we hope that more mothers could enjoy its benefits.
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Affiliation(s)
- S Lurie
- Department of Obstetrics and Gynecology, Hebrew University, Rehovot, Israel
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23
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Abstract
Epidural characteristics, when using different solutions for patient controlled epidural analgesia (PCEA), were compared in a randomised, blinded study in labour. Women in group 1 (n=23) self-administered 0.25% plain bupivacaine, in group 2 (n=23) 0.125% plain bupivacaine plus fentanyl 3 microg/ml and in group 3 (n=20) 0.0625% bupivacaine with adrenaline 1:250,000 plus fentanyl 3 microg/ml. There were no significant differences between groups with respect to the quality of obstetric pain relief or maternal satisfaction, the requirement for supplementary boluses of staff-administered solution or the incidence of side effects. There was more intense motor block after 3 hours of PCEA (odds ratio 3.33 for score 0 versus 1, 2 or 3) and a significantly higher ratio of demands received to demands made (P<0.03) in group 1 compared groups 2 and 3. The rate of bupivacaine utilisation was significantly higher in group 1 compared to groups 2 and 3 and lower in group 3 compared to 1 and 2 (median+interquartile range: 16+11-21 vs 9+6-11 vs 4+3-8 mg/hr, P<0.0002). Although all solutions provided effective pain relief for PCEA during labour, the use of a low-dose bupivacaine-fentanyl combination offers clinical advantages and further evaluation of such solutions is warranted.
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Affiliation(s)
- M J Paech
- Department of Anaesthesia, King Edward Memorial Hospital for Women, Perth, Australia
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Gambling DR, Huber CJ, Berkowitz J, Howell P, Swenerton JE, Ross PL, Crochetière CT, Pavy TJ. Patient-controlled epidural analgesia in labour: varying bolus dose and lockout interval. Can J Anaesth 1993; 40:211-7. [PMID: 8467542 DOI: 10.1007/bf03037032] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
This double-blind prospective study was designed to determine the best dose variables for patient-controlled epidural analgesia (PCEA) and to compare bolus-only PCEA with continuous infusion epidural analgesia (CIEA) during the first stage of labour. Five groups of parturients self-administered 0.125% bupivacaine with 1:400,000 epinephrine and fentanyl 2.5 micrograms.ml-1 using PCA pumps programmed as follows: Group A, 2 ml bolus/10 min lockout interval (LI); Group B, 3 ml bolus/15 min LI; Group C, 4 ml bolus/20 min LI; Group D, 6 ml bolus/30 min LI; Group E, 8 ml.hr-1 continuous infusion. Hourly assessments included: VAS scores for pain and satisfaction, sensory and motor block, bupivacaine and fentanyl consumption. Blood samples were collected at birth for maternal and fetal fentanyl concentrations. Data from 68 patients showed no differences among groups in pain relief or maternal satisfaction. Most patients received excellent analgesia and those requiring extra epidural supplements were evenly distributed across groups. There was higher consumption of bupivacaine and fentanyl in Group E than in any of the other four groups: bupivacaine mg.hr-1, mean (SD), 9.4 (2.7) in Group E vs 5.2 (1.7) in Groups A-D inclusive (P < 0.0001); fentanyl microgram.hr-1, 19.6 (4.6) in group E vs 12.6 (7.5) in Groups A-D inclusive (P < 0.05). Motor block was minimal, whereas sensory levels were higher at the 3- and 4-hour assessments in Groups D and E than in all other groups (P < 0.05). Plasma fentanyl concentrations were < 0.5 ng.ml-1 in all samples and no sequelae from fentanyl were observed, apart from mild pruritus.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D R Gambling
- Division of Obstetric Anaesthesia, University of British Columbia, Vancouver, Canada
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25
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Nolan JP, Dow AA, Parr MJ, Dauphinee K, Kalish M. Patient-controlled epidural analgesia following post-traumatic pelvic reconstruction. A comparison with continuous epidural analgesia. Anaesthesia 1992; 47:1037-41. [PMID: 1489025 DOI: 10.1111/j.1365-2044.1992.tb04197.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A randomised, single-blinded study was conducted to compare patient-controlled epidural analgesia with continuous infusion epidural analgesia for the treatment of pain following post-traumatic pelvic reconstruction. The patient-controlled group (n = 11) received a background infusion of 4 ml.h-1 of bupivacaine 0.125% with fentanyl 1 microgram.ml-1, and 3-6 ml bolus doses, self administered, as required (with a 15 min lockout interval). The continuous infusion group (n = 12) received a continuous infusion of the same solution through an identical apparatus, but with the demand button deactivated. This was started at 10 ml.h-1 and adjusted by the anaesthetist, as required, up to a maximum of 25 ml.h-1. Pain scores, side effects, and the volumes of drug infused were recorded over the first 3 postoperative days. One patient from each group was withdrawn because of catheter-related problems. Pain scores were similar and the incidence of nausea and pruritus was low in both groups. There was no recorded instance of respiratory depression or hypotension and there was no significant difference between the groups in the volumes of drug solution received. Patient satisfaction was equally very good in both groups. Patient-controlled epidural analgesia is an effective means of providing pain relief after post-traumatic pelvic reconstruction, but did not significantly reduce analgesic requirements in comparison with continuous infusion epidural analgesia.
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Affiliation(s)
- J P Nolan
- Department of Anaesthesia, Maryland Institute for Emergency Medical Services Systems (MIEMSS) Shock Trauma Center, Baltimore 21201
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26
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Paech MJ. Patient-controlled epidural analgesia in labour--is a continuous infusion of benefit? Anaesth Intensive Care 1992; 20:15-20. [PMID: 1609935 DOI: 10.1177/0310057x9202000103] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A randomised, single-blind study was conducted among 52 gravida in active labour, to investigate two variants of patient-controlled epidural analgesia--bolus only versus bolus plus infusion. Patient-controlled analgesia variables, using an epidural solution of 0.125% bupivacaine plus fentanyl 3 mcg per ml, were a 4 ml incremental bolus with 15 minute lockout, plus or minus a 4 ml per hour infusion. Up to three additional staff-administered supplements of 0.5% bupivacaine 4 ml (20 mg) were allowed. There was no significant difference between groups with respect to pain relief, supplementary boluses required, satisfaction, side-effects or details of patient-controlled epidural analgesia, with the exception of greater fentanyl usage in the bolus plus infusion group (P less than 0.003). Both groups had high quality analgesia, low rates of bupivacaine usage and were highly satisfied. However, under the conditions of the study, the addition of a continuous background infusion to self-administration conferred no benefit.
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Affiliation(s)
- M J Paech
- Department of Anaesthesia, King Edward Memorial Hospital for Women, Perth, Western Australia
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