Comparison of patient-controlled epidural analgesia and conventional intermittent "top-up" injections during labor

In a prospective, randomized manner, bolus injection patient-controlled epidural analgesia (PCEA; n = 30) and conventional intermittent "top-up" injections (CIT; n = 28) of bupivacaine in nulliparous parturients during first stage of labor were compared. Group A (PCEA) patients self-administered, using a patient-controlled analgesia device, 4-mL increments of 0.125% bupivacaine with 1: 400,000 epinephrine, to a maximum 12 mL/h as required. Group B (CIT) patients received 12 mL of the same solution, on request, from the anesthesiologist. Hourly assessments of pain relief (visual analogue scale), satisfaction, sensory and motor block, blood pressure, and cervical dilatation were made. In addition, retrospective pain assessments were made in patients requesting analgesia in the preceding hour, indicating their maximum pain during that time. The groups were demographically comparable and equally low hourly bupivacaine requirements were seen (group A, 6.36 +/- 0.43 mg; group B, 6.23 +/- 0.39 mg) producing similar mean sensory levels. Pain relief obtained in both groups was similar but was associated with greater satisfaction in patients using PCEA (P less than 0.05). This study shows that PCEA is a viable alternative for providing pain relief in the first stage of labor.