Optimal Regimen of Patient-Controlled Epidural Anesthesia in laboring patients receiving CSE for labor pain
Abstract Number: 121
Abstract Type: Original Research
INTRODUCTION- Continuous Epidural analgesia is accepted as the most effective ways of providing good pain relief in labor. Several studies1 have demonstrated that Patient Controlled Epidural Anesthesia (PCEA) is a novel and effective way of controlling labor pain. However, optimal dosage of medications for PCEA remains a controversial topic and clinical experience with PCEA is limited. Our aim is to find an optimal regimen for PCEA for labor analgesia in our institution.
METHODS - This is an IRB approved, prospective, randomized clinical trial. Parturients who received CSE for labor pain relief were assigned to one of the following five PCEA protocols; The medication used for epidural infusion was 0.1% Bupivacaine with 2.85 mcg/ml of Fentanyl.
Day Mon Tues Wednes Thurs Fri
Group A B C E D
Basal rate (cc/hr) 7 7 7 7 14
Demand dose(cc) 8 5 3 7 0
Lockout (#of doses/hr) 2 4 6 3 0
Lockout interval(min) 30 15 10 20 0
The following data was collected prior to the placement of CSE: Age, weight, parity,start of dilation,pain score and vital signs. Every 2 hours, after the CSE, blood pressure, heart rate, pain score, motor block (Bromage score), satisfaction score, PCEA boluses and Physician administered boluses were noted.
RESULTS:The total amount of pain medication used by different Groups showed no significant difference. The basal rate of infusion for Group C was significantly less (P<0.05) than for Group D. The number of boluses used in Group A was significantly less than in Group B (P<0.01) and C (P<0.05). Pain scores at hour 2 was significantly less in Group D than in Group B (P<0.01), Group C (P<0.05)and E (P<0.02). Satisfaction scores at hour 2 were significantly higher in Group D (P<0.02) than in Group C. Beyond 2 hours there was no significant difference in pain or satisfaction score among the group
Our hospital is a tertiary care center with a very busy Obstetric service-About 8000 deliveries per year; with an epidural analgesia rate of 90%. Optimal regimen will be considered superior if it allows for less number of physician administered boluses, as well as greater patient satisfaction and analgesia with minimal motor block. The analysis of the results indicates that Group D receiving basal rate infusion only without PCEA boluses seems to be the ooptimal regimen. This is a preliminary report of of our study.