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For labor analgesia, a low background infusion (0.028 mL/kg/h) in combination with a high-dose PCEA (10 mL, 40 min interval) is an efficacious and safe clinical application.
Low background infusion and a high dose of patient-controlled epidural analgesia (PCEA) can shorten the duration of effective patient-controlled analgesia (PCA), lower the frequency of breakout pain, and total amount of anesthetics without lessening analgesia effects, as deciphered from a recent randomized controlled trial. This study sought to assess the efficacy and safety of a high dose of PCEA with low background infusion for labor pain management.
Every 40 minutes, group LH received a continuous infusion (CI) of 0.084 mL/kg/h with 5 mL of PCEA. Group HL received a continuous infusion of 0.028 mL/kg/h and 10 mL of PCEA every 40 minutes, while Group HH received a continuous infusion of 0.084 mL/kg/h and 10 mL of PCEA every 40 minutes. The VAS pain score, the number of extra boluses, the frequency of pain outbreaks, the medication dose for pain outbreaks, the PCA times, effective PCA times, the amount of anesthesia consumed, the length of analgesia, and the length of labor and delivery were the main findings.
The secondary endpoints encompassed noxious reactions like nausea and vomiting during analgesia, itching, and neonatal Apgar scores one minute and five minutes following birth. Overall, 180 patients were divided into three groups at random: group LH, group HL, or group HH, with 60 patients in each group. In comparison to the LL group, the VAS scores in the HL group and the HH group were significantly lower at 2 hours following analgesia, the time of full cervical dilation, and the baby's delivery. In comparison with the LH group and the HL group, the third stage of labor took longer time in the HH group. Comparing the LH group to the HL and HH groups, there was a clear rise in the frequency of pain breakouts.
When compared to those in the LH group, the effective PCA times in the HL group and HH group were markedly shortened. Low background infusion and a high dose of PCEA is beneficial for labor pain management. But, a raised background infusion rate and an elevated dose of PCEA can raise the analgesic effect while raising labor's third stage, the instrumental delivery ratio, and the overall anesthetic usage.
Journal of Personalized Medicine
High Dosage of Patient-Controlled Epidural Analgesia (PCEA) with Low Background Infusion during Labor: A Randomized Controlled Trial
Yu Wei et al.
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