Recent advances in patient-controlled epidural analgesia for labour

Current Opinion in Anaesthesiology
S Halpern

Abstract

Patient-controlled epidural analgesia (PCEA) is a relatively new mode of maintenance of labour analgesia. The purpose of this review is to demonstrate that PCEA has several advantages over continuous-infusion analgesia and to discuss recent refinements in the use of PCEA for labour. Early investigations showed that PCEA without background infusion reduced the incidence of motor block and the amount of local anaesthetic needed to produce satisfactory analgesia compared to continuous infusions. Recent studies have shown that the addition of a background infusion to PCEA may be advantageous, depending on the patient population and the rate of the continuous infusion. Both bupivacaine and ropivacaine have been used in PCEA but ropivacaine may be associated with a reduced incidence of motor block in parturients who have epidural analgesia for long periods of time. Of note, very low concentrations of local anaesthetics are required to produce satisfactory analgesia. PCEA has proven to be a safe, convenient, and highly effective way to maintain labour analgesia. Parturients appreciate the control they have over the analgesia received throughout labour when this method is used.

References

May 1, 1988·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·D R GamblingL Palmer
Oct 31, 2002·British Journal of Anaesthesia·M van der VyverG Joseph
Sep 13, 2003·Acta Anaesthesiologica Scandinavica·S Ledin ErikssonC H Olofsson
Sep 16, 2003·Clinical Obstetrics and Gynecology·Robert D'Angelo
Jul 1, 1960·Canadian Anaesthetists' Society Journal·S M EISENE SHEFFMAN
Jan 1, 1996·International Journal of Obstetric Anesthesia·D Bogod

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Citations

Feb 2, 2011·Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology·S SkrablinJ Blajic
Apr 29, 2014·Taiwanese Journal of Obstetrics & Gynecology·Shin-Yan ChenLi-Kuei Chen
Aug 10, 2007·The Journal of Pain : Official Journal of the American Pain Society·Manuel C VallejoNeera Sah
Nov 11, 2011·American Journal of Obstetrics and Gynecology·Michael L HaydonMichael P Nageotte
Mar 16, 2012·The Cochrane Database of Systematic Reviews·Leanne JonesJames P Neilson
Jan 12, 2007·International Anesthesiology Clinics·Richard M Smiley, Leroi Stephenson

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