Patient-controlled epidural analgesia (PCEA) versus continuous epidural infusion analgesia (CEIA) for labour using levobupivacaine

V. Dorca¹, Diana Feier³, Anca Bălintescu¹, Ioana Belciu¹, Daria Groza¹, S. Ciuchinã²

1 Spitalul Clinic de Urgenţă „Prof. Dr. O. Fodor”, Clinica Obstetrică-ginecologie „Dominic Stanca”, Secţia ATI III
2 Spitalul Clinic de Urgenţă „Prof. Dr. O. Fodor”, Clinica Obstetrică-ginecologie „Dominic Stanca”, Secţia Obstetrică-ginecologie
3 Spitalul Clinic Judeţean de Urgenţă Cluj, Clinica de Radiologie şi Imagistică Medicală, Cluj-Napoca

Abstract

Background and aim: Patient-controlled epidural analgesia (PCEA) is considered to be an attractive alternative to continuous epidural infusion analgesia (CEIA), for providing labor analgesia. The aim of this study was to determine the efficacy of these two techniques during labor using levobupivacaine.

Methods: The study enrolled in a prospective, randomized manner, 94 ASA I parturients. 41 parturients received PCEA, using an initial bolus of 10 ml 0.250% levobupivacaine, and then on demand doses of 5 ml 0.125% solution every 15 minutes. The other 53 parturients were given continuous epidural infusion, with the initial bolus of 10 ml of the 0.250% solution, and then 7 ml/hour of the 0.125% solution. There were no opioid drugs added in the labor analgesia. During the study, the measured variables included demographic and obstetrical data, motor block (Bromage score), sensory block, delivery and neonatal outcome, maternal satisfaction, total epidural dose, pain on Visual Analog Scale (VAS, 0-10), side-effects.

Results: There were differences concerning pain VAS variation in time at 1 h, 2 h 30 min and 4 h 15 min from the beginning of labor (p = 0,001) and regarding cervical dilatation at 7 cm (p = 0,001); motor block [2 patients (4.87%) in PCEA versus 21 patients (39.7%) in CEIA] and in respect to delivery outcome – instrumental intervention [PCEA 2 patients (2,12%) versus CEIA 14 patients (14,89%), p < 0.0001]. No differences were noted with respect to demographic data, total epidural dose and the dose/hour, sensory block, neonatal outcome and maternal satisfaction score, which was high in both groups.

Conclusion: Compared with CEIA, the PCEA with levobupivacaine provided a relatively adequate analgesia, good quality of sensory block and signifincantly reduced incidences of motor block and number of instrumental interventions during birth.

Keywords: PCEA, CEIA, labour, levobupivacaina, motor block

J Rom Anest Terap Int 2009; 16: 99-106

Analgezia peridurală controlată de către pacientă comparativ cu infuzia peridurală continuă la naştere folosind levobupivacaina