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A Comparison of Meperidine PCEA With and WIthout Basal Rate for Post-Cesarean Analgesia
Abstract Number: T-12
Abstract Type: Original Research
Background: Continuous infusion of epidural meperidine has provided safe and effective post-cesarean section (CS) analgesia at our hospital for over 30 years. Patient-controlled techniques can provide better pain relief, patient satisfaction, and reduced side effects compared with continuous techniques so we wanted to add that to our practice. We hypothesized that adding a basal rate to patient-controlled epidural analgesia (PCEA) would not improve analgesia based on the results of a prior study.(1)
Methods: 273 patients undergoing scheduled CS at Mercy Hospital St. Louis were randomly assigned to one of two groups: meperidine PCEA (NB) with 20 mg demand bolus with 30 minute lockout or PCEA with basal rate of 20 mg/hr with same bolus settings (B). Epidural meperidine was initiated after delivery and continued up to the second post-operative morning unless patient request or dressing or IV failure resulted in early discontinuation. Patients, nurses, and research personnel were blinded to the treatment groups. Data obtained included verbal pain scores (VPS 0-10) as recorded by the nurses, basic demographic data (age, BMI, primary vs repeat CS), administration of nalbuphine or diphenhydramine for pruritis, ondansetron for nausea, and patient satisfaction using the Revised American Pain Society Patient Outcome Questionnaire (2). Data were analyzed using Fisher’s Exact tests and unpaired t tests where appropriate.
Results: 256 of 273 patients completed the study with 127 in the NB and 129 in the B groups. Satisfaction data was available for 240 patients (122 in NB and 118 in B). There was no difference with respect to age, primary vs repeat CS, use of ordered non-steroidal anti-inflammatory drugs, or length of epidural post-op use. There was a statistically significant difference in BMI with an average of 34.03 in the NB group and 32.18 in the B group (p=0.03). Analysis of the primary outcome variable of mean VPS with movement showed significantly more pain in the NB group (1.92 NB vs 1.50 B p=0.03 95% CI 0.32, 1.51). When administration of medications to treat side effects was analyzed, all were found to be statistically similar with the exception of nalbuphine given for itching (14 in NB vs 4 in B, p=0.01). Survey data for the 24 hours following surgery showed significant differences for the following questions: worst pain experienced (5.79 NB vs 5.10 B p=0.01 95% CI 0.16, 1.21), pain interfering with activities in bed (4.04 NB vs 3.13 B p=0.003 95% CI 0.32, 1.51), reported drowsiness (2.26 NB vs 2.91 B p=0.04 95% CI -1.26, -0.03), and overall satisfaction (8.76 NB vs 9.41 B p=0.003 95% CI 0.32, 1.51). The other responses were not statistically significantly different between the two groups.
Conclusions: Addition of a basal rate to meperidine PCEA resulted in less itching and improved analgesia and patient satisfaction. It did result in more drowsiness.
1. Ngan Kee et al Can J Anaesthesia 1997
2. D Gordan et al J Pain 2011