Ultralight Epidural Works as Both Infusion, Patient-Controlled Bolus


BANFF, ALTA. — Ultralight doses of epidural analgesia given either as a continuous infusion or as patient-controlled boluses appear to result in comparable pain and Apgar scores as well as medication usage, according to the preliminary results of an ongoing study.

“Our numbers are very small right now, but as soon as we get more I am sure we will see a statistical difference between the two in terms of patient satisfaction,” predicted Dr. Maya Suresh, chief of obstetric anesthesiology at Baylor College of Medicine, Houston. “I think patient-controlled epidural analgesia [PCEA] is advantageous to the patient because she is in control of her own pain. And, if you are not called frequently to intervene or to trouble-shoot that also adds to the provider's satisfaction,” she said in an interview.

The study, presented at the annual meeting of the Society for Obstetric Anesthesia and Perinatology, is the first to compare outcomes using an ultralight epidural solution of 0.0625% bupivacaine plus 2 mcg/mL fentanyl. Fifteen nulliparous parturients requesting epidural were randomized to the continuous-infusion epidural analgesia (CIEA) arm and received the solution at a dose of 14 L/hr. Another 15 women were randomized to PCEA and received an 8-mL/hr background infusion of the same solution with the option for 5-mL boluses on demand at a 5-minute lockout interval, and an hourly limit of 26 mL, reported Dr. LaToya Mason from the same institution, who presented the study.

There was no statistically significant difference between the groups in umbilical artery pH scores, Apgar scores, or pain scores, said Dr. Mason. All patients had spontaneous vaginal deliveries except for four who had cesareans (two in each group).

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