When women administer their own patient-controlled epidural analgesia (PCEA) instead of getting a continuous epidural infusion (CEI) they used less analgesic, but reported similar levels of satisfaction. These findings will be presented by researchers today at the Society for Maternal-Fetal Medicine's (SMFM) annual meeting, The Pregnancy Meeting ™, in San Francisco.
Women often receive a continuous epidural infusion of analgesic during labor. This can lead to prolonged labor and an increase in assisted vaginal delivery. Several pain management studies have been done to begin looking at how much analgesia women use and what their pain experience is like when they are able to administer it themselves.
"We conducted the first double blind study, excluding inductions and including only women who were delivering for the first time, so that we could get a good sample of women with similar labor patterns," said Michael Haydon, M.D., one of the study's authors.
The study results showed that total mg bupivicaine used was less in the PCEA only group compared to CEI; group 1 (74.9 ± 36 mg), group 2 (95.9 ± 52 mg), group 3 (52.8 ± 42 mg) p<.001. No differences were seen in total time of labor; group 1 (8.4 hr), group 2 (7.9 hr), group 3 (8.0 hr) or cesarean delivery; group 1 (26/87), group 2 (23/84), and group 3 (22/85). Number of instrumented vaginal deliveries was slightly higher in subjects with a continuous background infusion; group 1 (8/87), group 2 (8/84), group 3 (3/85). Neither lower extremity strength nor urge to push were affected by method of epidural. Pain with pushing, however, was worse in PCEA only. Median satisfaction scores were similar; 0 (best)-100(worst); group 1: 0 (0-100), group 2: 0 (0-100), group 3: 0 (0-100).
The study concluded that PCEA resulted in 30 percent less analgesia being used while maintaining high maternal satisfaction. There was also a trend toward reduction in instrumented vaginal deliveries in the PCEA only group.
"Though patients in each group showed equal satisfaction, we did note that there was more pain during the final delivery stage in the PCEA group," said Haydon. "The next step is to look at shortening the lock-out intervals between doses, or having the option of administering additional analgesia during the final pushing stage."
Haydon also noted that, in future, he expects the technology to move in the direction of automated analgesia delivery in response to patient need.