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///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

Institutional analysis during conversion to patient controlled epidural analgesia from continuous epidural infusion for laboring patients

Abstract Number: 74
Abstract Type: Original Research

Liane Germond MD1 ; D Stein MD2; C Ciliberto MD3; J Epstein MD4; D Kassapidis DO5; J Marenco MD6

In the last decade, patient controlled epidural analgesia (PCEA) has become standard in controlling labor pain. The most recent review of the literature by Halpern and Carvalho illustrated that this mode of anesthetic administration decreases the incidence of physician interventions and decreases the total dose of local anesthetics, but provides no difference in patient satisfaction. (Anesth Analg 2009;108:921-8) During our institutions conversion from continuous epidural infusion (CEI) to PCEA, we decided to do an internal review of a sample of our laboring patients to determine if the results previously found in the literature are concordant with our patient population.

As laboring patients requested analgesia, they were asked to participate in this internal review. If the patient agreed, she was randomized to one of two groups, the first receiving CEI, and the other PCEA. The patients were all ASA class 2 and each received a standard CSE with 1 ml 0.25% Bupivacaine and 20 mcg Fentanyl. The epidural infusion bags were also standardized with 0.0625% Bupivacaine and 2 mcg/ml of Fentanyl. The CEI patients had an infusion rate of 12 ml/hr, while the PCEA patients had an infusion rate of 12 ml/hr as well as a demand dose of 8 ml with a lockout of 10 minutes. A total of 46 patients were ultimately analyzed for this review.

The patients in the two groups had similar average ages (32), gravidity (1.7-1.9), parity (0.2-0.6), and dilation at time of CSE placement (4-5). The average length of infusion for the PCEA patients was longer than that of the CEI patients (596 minutes vs. 312 minutes). This was likely due to a greater number of CEI patients on pitocin for augmentation of labor than in the PCEA group (23% vs. 15%). 43% of patients in the CEI group required physician intervention for pain relief, while only 13% required this in the PCEA group. Of those receiving a PCEA, 61% used additional self-administered boluses of the epidural solution. The average total dose of local anesthetic was less in the PCEA group compared to that of the CEI group (62 mg vs. 73 mg). Lastly, patient satisfaction was similar in the 2 groups (95-96% satisfied), although only 83% of the PCEA patients would recommend this type of analgesia to their friends compared with 95% of the CEI patients.

Our internal review demonstrated similar results as those seen in the recent literature. Patients receiving PCEA for labor analgesia had a decreased incidence of physician interventions for breakthrough pain, had a decrease in the total dose of local anesthetic used, but showed no difference in patient satisfaction. Interestingly, patient recommendation of the PCEA was found to be less than that of patients who had a traditional epidural infusion.

SOAP 2010