Clinical experience with patient-controlled and staff-administered intermittent bolus epidural analgesia in labour

A prospective, randomized study was performed to detail clinical experience with both patient-controlled epidural analgesia (PCEA) and midwife-administered intermittent bolus (IB) epidural analgesia during labour, under the conditions pertaining in a busy obstetric delivery unit. Both methods used 0.125% bupivacaine plus fentanyl, and similar rescue supplementation, although management decisions related to epidural analgesia were made principally by attending midwives. One hundred and ninety-eight women were recruited and data analysed from 167 (PCEA n = 82, IB n = 85). The groups were demographically similar. Median hourly pain scores, ratings of analgesia and satisfaction did not differ. Maximum pain scores were significantly higher in those receiving IB epidural analgesia (P < 0.05). The PCEA group had a significantly higher rate of supplementation and bupivacaine use (P < 0.01), and a longer duration of the second stage of labour (P < 0.03). The relative risk of instrumental delivery with PCEA versus the IB method was 1.57 (CI 1.07-2.38). Experience within our unit with PCEA is contrasted with that of IB epidural analgesia, the method most commonly used; and with that of controlled trials comparing these two methods.