[The use of patient-controlled analgesia by the obstetrical patient]

Patient-controlled analgesia is a technique of analgesia recently developed for obstetrical pain. During labor, PCA using intravenous administration has already been used for more than a decade but meperidine may be conceivable replaced by fentanyl with which maternal and neonatal side-effect seem reduced. This analgesic technique is however less efficacious than epidural analgesia and thus might essentially be useful in situations when the latter is contra-indicated. During labor, patient-controlled epidural analgesia (PCEA) may produce powerful pain relief and may reduce local anesthetic doses thus reducing motor blockade. After cesarean section, PCA using intravenous morphine has been shown to produce less pain relief than epidural morphine but is associated with a high degree of satisfaction. The wider use of PCA in obstetrics is however limited by its cost and will thus require evaluation of its cost/effectiveness ratio.