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

Meta-analysis of the Efficacy of PCEA (with background infusion) versus Continuous Infusion for Labor Analgesia

Abstract Number: 16
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 analgesia (PCEA) and continuous epidural infusions of local anesthetic are widely accepted methods for labor analgesia. The overall efficacy of PCEA with a background infusion compared to continuous infusion for labor analgesia is uncertain. We have performed a meta-analysis to further examine this issue.

Method: This study qualified for exemption 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 (demand dose with a background infusion) to continuous epidural analgesia 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 the 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 193 subjects for the PCEA group and 186 for the CEI group. Pooled estimates indicated that there were no difference in the duration of first stage (weighted mean difference [WMD] = 5.9 min, 95% confidence interval [CI]: -28.0, 39.7) or second stage (WMD = -5.7 min, 95% CI: -15.5, 4.2) of labor between the groups. There also was no difference in relative risk of Cesarean section (relative risk [RR] = 1.3, 95% CI: 0.8, 2.2) or instrumented deliveries (RR = 1.0, 95% CI: 0.7, 1.4) between the groups.

Conclusions: Our pooled analysis of PCEA with a background infusion versus continuous infusion for labor analgesia suggest that there are no significant differences between the two methods for delivery of labor analgesia based on outcomes criteria examined. Further examination with a large RCT may be warranted as the overall number of subjects is relative small.

SOAP 2009