///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

The Effect of Background Infusion for PCEA on Labor Analgesia: A Meta-analysis

Abstract Number: 10
Abstract Type: Meta Analysis/Review of the Literature

Kerry Blaha MD1 ; Jamie Murphy MD2; Gillian Newman MD, PhD3; Cristianna Vallera MD4; Marie Hanna MD5; Christopher Wu MD6

Objective: Patient-controlled epidural analgesia (PCEA) of local anesthetic is a widely accepted method for labor analgesia. The effect of a background infusion for PCEA on outcomes such as duration of labor, Cesarean section, and instrumented deliveries is uncertain. We have performed a meta-analysis to further examine this issue.

Method: This project is exempt from the Johns Hopkins IRB. A systematic literature search of the National Library of Medicines PubMed database was conducted for terms related to PCEA for labor analgesia (epidural or extradural, patient-controlled or PCEA or patient controlled, labor or labour or pregnant or pregnancy or parturient). Only randomized controlled trials in the English language comparing PCEA with and without background infusion for labor analgesia were included for analysis. Data on pertinent study characteristics and relevant outcomes were extracted from accepted articles. Meta-analysis was performed using Review Manager 4.2.10 (The Cochrane Collaboration, 2004). A random effects model was used.

Results: The literature search yielded 718 articles of which 7 met all inclusion criteria. There were a total of 192 subjects in the PCEA group without background infusion and 196 in the PCEA with background group. Pooled estimates indicated that there was a significant increase in the duration of the first stage of labor (weighted mean difference [WMD] = 31.6 min, 95% confidence interval [CI]: 12.3, 51.0) in the group without a background infusion. There was also a significant increase in the duration of the second stage of labor with PCEA with background infusion ([WMD] = -13.9 min, 95% confidence interval [CI]: -5.4, -2.3). There was no difference in relative risk of Cesarean section (relative risk [RR] = 0.9, 95% CI: 0.6, 1.4) or instrumented deliveries (RR = 0.7, 95% CI: 0.5, 1.1) between the groups.

Conclusions: Our pooled analysis of demand dosing PCEA with and without background infusion for labor analgesia suggest that there are no significant differences between the two methods when examining the outcomes of Cesarean section and instrumented delivery. There was a statistically significant increase in duration of the first stage of labor with PCEA without background infusion and an increase in the second stage of labor with PCEA with background infusion. These unexpected conclusions may be the result of the limited number of subjects pointing to the need for further examination with a large RCT.

SOAP 2009