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

BACKGROUND: Patient-controlled epidural analgesia (PCEA) is a common practice for labor pain relief. This study aimed to compare two different settings of a PCEA device using the same solution to obtain labor analgesia.

METHODS: Fifty-two parturients were randomly allocated to receive ropivacaine 0.15% and fentanyl 2 γ/mL via a PCEA device either as a background infusion of 5 mL/h plus 5 mL demand bolus doses with 10-minute lockout (group B/D, N.=26) or as only demand bolus doses of 5 mL with 10-minute lockout (group D, N.=26). The primary outcome was the total volume of local anesthetic administrated during labor; 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 labor, 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 anesthetic 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 minutes 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 anesthetic consumption and reduced breakthrough pain without affecting maternal satisfaction and neonatal outcomes.