Patient-controlled epidural analgesia during labour: example of a protocol

M. Lerinţiu¹, Simona Angheloiu², Zvetlana Chetrar¹

1) Clinica Ginecologie I, Spitalul Clinic Judeţean de Urgenţă, Cluj-Napoca
2) Clinica ATI, Spitalul Clinic de Adulţi, Cluj-Napoca

Abstract

The aim of this study was to determine the efficacy of a patient-controlled epidural analgesia mode in parturients, during labor.

Methods. This study was conducted on 26 parturients. The used epidural solution was 0.1% ropivacaine with fentanyl. The PCEA settings were as follows: an initial bolus of 10 ml 0.1% ropivacaine with 50 µ fentanyl, a demand dose of 5 ml 0.1% ropivacaine with 2.5 microgr/ml fentanyl, a lock-out interval of 10 min, no basal infusion and a maximum volume per hour of 20 ml 0.1% ropivacaine with 2.5 µ/ml fentanyl. The degree of pain relief, limbs motor block, haemodynamic parameters, side effects, mode of delivery, Apgar scores of the newborns and a measure of maternal satisfaction were assessed. Variables studied were the patient-controlled epidural analgesia ratio, the amount of drug used, the duration and the efficacy of the initial dose.

Results. The degree of pain relief was 92.19%, with no motor block, hypotension or side effects (only pruritus in 3 cases). The spontaneous delivery rate was 80.76% and caesarean delivery rate was 19.24%. Neonatal outcome was good (Apgar scores over 8). Patients’ satisfaction was rated excellent. The mean duration of analgesia was 3 hour and 35 minute, the total amount of ropivacaine used was 30.38 ml, initial bolus efficacy was 65.38% and patient-controlled epidural analgesia ratio was 65.12%

Conclusions. This mode of analgesia was associated with high patient satisfaction, because they become the manager of their own pain relief. The obstetrician appreciated the minimal interference with labor and the quality of delivery. The anesthesiologist appreciated the efficacy of the method and the minimal workload.

Key words: obstetrics analgesia, analgesia, epidural, patient-controlled analgesia, ropivacaine, fentanyl

Analgezia peridurală la naştere controlată de pacientă. Exemplu de protocol

Jurnalul Român de Anestezie Terapie intensivă 2006 Vol.13 Nr.2, 110-116