MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,623

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Minerva Anestesiologica 2018 Jan 16

DOI: 10.23736/S0375-9393.18.12070-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Patient controlled epidural analgesia with and without basal infusion using ropivacaine 0.15% and fentanyl 2γ/mL for labour analgesia: a prospective comparative randomised trial

Paraskevi K. MATSOTA ¹ ✉, Kalliopi H. DRACHTIDI ¹, Chrysanthi Z. BATISTAKI ¹, Agathi V. KARAKOSTA ², Ioanna C. KOUKOPOULOU ¹, Eugenia I. KOURSOUMI ¹, Georgia G. KOSTOPANAGIOTOU ¹

¹ 2nd Department of Anaesthesiology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece; ² Thriassio General Hospital, NHS, Magoula, Athens, Greece

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BACKGROUND: Patient-Controlled Epidural Analgesia (PCEA) is a common practice for labour pain relief. This study aimed to compare two different settings of a PCEA device using the same solution to obtain labour analgesia.
METHODS: Fifty two parturients were randomly allocated to receive ropivacaine 0.15% and fentanyl 2γ/mL via a PCEA device either as a background infusion of 5mL/h plus 5mL demand bolus doses with 10 min lockout (group B/D, n=26) or as only demand bolus doses of 5mL with 10 min lockout (group D, n=26). The primary outcome was the total volume of local anaesthetic administrated during labour; secondary outcomes included the analgesic efficacy and the effects on maternal and neonatal outcomes.
RESULTS: No statistical difference was observed between the groups concerning demographic characteristics, duration of first and second stages of labour, administration of oxytocin and ephedrine, rescue doses, instrumental delivery, Bromage scale, maternal side effects and satisfaction, neonatal Apgar scores and pH. The total volume of local anaesthetic was greater in group B/D compared to group D (p=0.015). A statistically significant difference was detected in VAS scores only at the end of the second stage (p=0.036) and at 60 min from the test dose administration (p=0.022) and with group D exhibited higher pain scores than group B/D. The incidence of breakthrough pain (VAS>4) was higher in group D compared with Group B/D (p=0.035).
CONCLUSIONS: The addition of background infusion plus PCEA demand bolus doses increased local anaesthetic consumption and reduced breakthrough pain without affecting maternal satisfaction and neonatal outcomes.

KEY WORDS: PCEA - Labour analgesia - Background infusion - Ropivacaine - Fentanyl