“Ultra-light” patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload
Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for maintenance of labor analgesia. Some of these benefits may depend on the PCEA settings. This study evaluated several regimens for “ultra-light” (0.125%) PCEA with basal continuous infusion (CI)...
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| Veröffentlicht in: | International journal of obstetric anesthesia 2005-07, Vol.14 (3), p.223-229 |
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| container_title | International journal of obstetric anesthesia |
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| creator | Carvalho, B. Cohen, S.E. Giarrusso, K. Durbin, M. Riley, E.T. Lipman, S. |
| description | Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for maintenance of labor analgesia. Some of these benefits may depend on the PCEA settings. This study evaluated several regimens for “ultra-light” (0.125%) PCEA with basal continuous infusion (CI) in labor with goals of minimizing physician interventions while providing good analgesia.
Two hundred and twenty ASA I-II women receiving epidural analgesia during active labor (cervical dilation |
| doi_str_mv | 10.1016/j.ijoa.2005.02.003 |
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Two hundred and twenty ASA I-II women receiving epidural analgesia during active labor (cervical dilation <5 cm) were randomly assigned in a double-blind manner to four treatment groups (
n
=
30 in each). Analgesia was maintained with a PCEA/CI pump using bupivacaine 0.0625%
+
sufentanil 0.35 μg/mL. PCEA settings were: group A: CI 10 mL/h, PCEA bolus 6 mL, 8-min lockout; group B: CI 10 mL/h, PCEA bolus 12 mL, 16-min lockout; group C: CI 15 mL/h, PCEA bolus 6 mL, 8-min lockout; group D: CI 15 mL/h, PCEA bolus 12 mL, 16-min lockout.
In groups A, B, C and D, 76, 77, 75 and 85% of parturients respectively, required no physician rescue boluses. Pain scores were low and maternal satisfaction was high in all groups, with minimal differences among them. Spontaneous vaginal delivery occurred in 78% of patients overall, instrumental (forceps or vacuum) delivery in 10% and cesarean section in 12%.
These ultra-light PCEA regimens provided excellent analgesia with minimal physician workload and a high spontaneous delivery rate. Use of moderate to high-volume, ultra-light PCEA/CI techniques should facilitate provision of labor analgesia in busy obstetric units.</description><identifier>ISSN: 0959-289X</identifier><identifier>EISSN: 1532-3374</identifier><identifier>DOI: 10.1016/j.ijoa.2005.02.003</identifier><identifier>PMID: 15935646</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Adult ; Analgesia ; Analgesia, Epidural - adverse effects ; Analgesia, Obstetrical - adverse effects ; Analgesia, Patient-Controlled - adverse effects ; Anesthetics, Intravenous ; Anesthetics, Local ; Apgar Score ; Bupivacaine ; Double-Blind Method ; Endpoint Determination ; Female ; Humans ; Infant, Newborn ; Labor ; Labor, Obstetric ; Pain Measurement - drug effects ; Patient-controlled epidural analgesia ; Pregnancy ; Pregnancy Outcome ; Sufentanil ; Workload</subject><ispartof>International journal of obstetric anesthesia, 2005-07, Vol.14 (3), p.223-229</ispartof><rights>2005 Elsevier Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c354t-60a381e82135433f256fa4bbcdc7dc4b86de9339745efd3086ab68b9b25c34783</citedby><cites>FETCH-LOGICAL-c354t-60a381e82135433f256fa4bbcdc7dc4b86de9339745efd3086ab68b9b25c34783</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0959289X05000324$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15935646$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Carvalho, B.</creatorcontrib><creatorcontrib>Cohen, S.E.</creatorcontrib><creatorcontrib>Giarrusso, K.</creatorcontrib><creatorcontrib>Durbin, M.</creatorcontrib><creatorcontrib>Riley, E.T.</creatorcontrib><creatorcontrib>Lipman, S.</creatorcontrib><title>“Ultra-light” patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload</title><title>International journal of obstetric anesthesia</title><addtitle>Int J Obstet Anesth</addtitle><description>Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for maintenance of labor analgesia. Some of these benefits may depend on the PCEA settings. This study evaluated several regimens for “ultra-light” (0.125%) PCEA with basal continuous infusion (CI) in labor with goals of minimizing physician interventions while providing good analgesia.
Two hundred and twenty ASA I-II women receiving epidural analgesia during active labor (cervical dilation <5 cm) were randomly assigned in a double-blind manner to four treatment groups (
n
=
30 in each). Analgesia was maintained with a PCEA/CI pump using bupivacaine 0.0625%
+
sufentanil 0.35 μg/mL. PCEA settings were: group A: CI 10 mL/h, PCEA bolus 6 mL, 8-min lockout; group B: CI 10 mL/h, PCEA bolus 12 mL, 16-min lockout; group C: CI 15 mL/h, PCEA bolus 6 mL, 8-min lockout; group D: CI 15 mL/h, PCEA bolus 12 mL, 16-min lockout.
In groups A, B, C and D, 76, 77, 75 and 85% of parturients respectively, required no physician rescue boluses. Pain scores were low and maternal satisfaction was high in all groups, with minimal differences among them. Spontaneous vaginal delivery occurred in 78% of patients overall, instrumental (forceps or vacuum) delivery in 10% and cesarean section in 12%.
These ultra-light PCEA regimens provided excellent analgesia with minimal physician workload and a high spontaneous delivery rate. Use of moderate to high-volume, ultra-light PCEA/CI techniques should facilitate provision of labor analgesia in busy obstetric units.</description><subject>Adult</subject><subject>Analgesia</subject><subject>Analgesia, Epidural - adverse effects</subject><subject>Analgesia, Obstetrical - adverse effects</subject><subject>Analgesia, Patient-Controlled - adverse effects</subject><subject>Anesthetics, Intravenous</subject><subject>Anesthetics, Local</subject><subject>Apgar Score</subject><subject>Bupivacaine</subject><subject>Double-Blind Method</subject><subject>Endpoint Determination</subject><subject>Female</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Labor</subject><subject>Labor, Obstetric</subject><subject>Pain Measurement - drug effects</subject><subject>Patient-controlled epidural analgesia</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Sufentanil</subject><subject>Workload</subject><issn>0959-289X</issn><issn>1532-3374</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kL1uFDEUhS0EIkvgBSiQK7oZ_DP2jBENiviTIqUhEp3lse9svHjtwZ4NSpeGtwgvlyfBq10pqaiu7r3nHOl8CL2mpKWEyneb1m-SaRkhoiWsJYQ_QSsqOGs477unaEWUUA0b1I8T9KKUDSFE8UE-RydUKC5kJ1foz_3t3WVYsmmCX18t97d_8WwWD3FpbIpLTiGAwzB7t8smYBNNWEPxBtfdxzUOZkz5PYZpArsUnCZ8bfLN_pNh7bcQ6y0-spno8Hx1U7z1JuLfKf8MybiX6NlkQoFXx3mKLj9_-n72tTm_-PLt7ON5Y7nolkYSwwcKA6N15XxiQk6mG0frbO9sNw7SgeJc9Z2AyXEySDPKYVQjE5Z3_cBP0dtD7pzTrx2URW99sRCCiZB2RcteqY4KUYXsILQ5lZJh0nP229pMU6L38PVG7-HrPXxNmK7wq-nNMX03bsE9WI60q-DDQQC147WHrIutqC04nys-7ZL_X_4_7L2amw</recordid><startdate>20050701</startdate><enddate>20050701</enddate><creator>Carvalho, B.</creator><creator>Cohen, S.E.</creator><creator>Giarrusso, K.</creator><creator>Durbin, M.</creator><creator>Riley, E.T.</creator><creator>Lipman, S.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20050701</creationdate><title>“Ultra-light” patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload</title><author>Carvalho, B. ; Cohen, S.E. ; Giarrusso, K. ; Durbin, M. ; Riley, E.T. ; Lipman, S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c354t-60a381e82135433f256fa4bbcdc7dc4b86de9339745efd3086ab68b9b25c34783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Analgesia</topic><topic>Analgesia, Epidural - adverse effects</topic><topic>Analgesia, Obstetrical - adverse effects</topic><topic>Analgesia, Patient-Controlled - adverse effects</topic><topic>Anesthetics, Intravenous</topic><topic>Anesthetics, Local</topic><topic>Apgar Score</topic><topic>Bupivacaine</topic><topic>Double-Blind Method</topic><topic>Endpoint Determination</topic><topic>Female</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Labor</topic><topic>Labor, Obstetric</topic><topic>Pain Measurement - drug effects</topic><topic>Patient-controlled epidural analgesia</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Sufentanil</topic><topic>Workload</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Carvalho, B.</creatorcontrib><creatorcontrib>Cohen, S.E.</creatorcontrib><creatorcontrib>Giarrusso, K.</creatorcontrib><creatorcontrib>Durbin, M.</creatorcontrib><creatorcontrib>Riley, E.T.</creatorcontrib><creatorcontrib>Lipman, S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of obstetric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Carvalho, B.</au><au>Cohen, S.E.</au><au>Giarrusso, K.</au><au>Durbin, M.</au><au>Riley, E.T.</au><au>Lipman, S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>“Ultra-light” patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload</atitle><jtitle>International journal of obstetric anesthesia</jtitle><addtitle>Int J Obstet Anesth</addtitle><date>2005-07-01</date><risdate>2005</risdate><volume>14</volume><issue>3</issue><spage>223</spage><epage>229</epage><pages>223-229</pages><issn>0959-289X</issn><eissn>1532-3374</eissn><abstract>Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for maintenance of labor analgesia. Some of these benefits may depend on the PCEA settings. This study evaluated several regimens for “ultra-light” (0.125%) PCEA with basal continuous infusion (CI) in labor with goals of minimizing physician interventions while providing good analgesia.
Two hundred and twenty ASA I-II women receiving epidural analgesia during active labor (cervical dilation <5 cm) were randomly assigned in a double-blind manner to four treatment groups (
n
=
30 in each). Analgesia was maintained with a PCEA/CI pump using bupivacaine 0.0625%
+
sufentanil 0.35 μg/mL. PCEA settings were: group A: CI 10 mL/h, PCEA bolus 6 mL, 8-min lockout; group B: CI 10 mL/h, PCEA bolus 12 mL, 16-min lockout; group C: CI 15 mL/h, PCEA bolus 6 mL, 8-min lockout; group D: CI 15 mL/h, PCEA bolus 12 mL, 16-min lockout.
In groups A, B, C and D, 76, 77, 75 and 85% of parturients respectively, required no physician rescue boluses. Pain scores were low and maternal satisfaction was high in all groups, with minimal differences among them. Spontaneous vaginal delivery occurred in 78% of patients overall, instrumental (forceps or vacuum) delivery in 10% and cesarean section in 12%.
These ultra-light PCEA regimens provided excellent analgesia with minimal physician workload and a high spontaneous delivery rate. Use of moderate to high-volume, ultra-light PCEA/CI techniques should facilitate provision of labor analgesia in busy obstetric units.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>15935646</pmid><doi>10.1016/j.ijoa.2005.02.003</doi><tpages>7</tpages></addata></record> |
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| ispartof | International journal of obstetric anesthesia, 2005-07, Vol.14 (3), p.223-229 |
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| subjects | Adult Analgesia Analgesia, Epidural - adverse effects Analgesia, Obstetrical - adverse effects Analgesia, Patient-Controlled - adverse effects Anesthetics, Intravenous Anesthetics, Local Apgar Score Bupivacaine Double-Blind Method Endpoint Determination Female Humans Infant, Newborn Labor Labor, Obstetric Pain Measurement - drug effects Patient-controlled epidural analgesia Pregnancy Pregnancy Outcome Sufentanil Workload |
| title | “Ultra-light” patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload |
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