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A randomised comparison of variable‐frequency automated mandatory boluses with a basal infusion for patient‐controlled epidural analgesia during labour and delivery
Author(s) -
Sia A. T.,
Leo S.,
Ocampo C. E.
Publication year - 2013
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.12093
Subject(s) - medicine , anesthesia , bolus (digestion) , ropivacaine , analgesic , pethidine , basal (medicine) , surgery , insulin
Summary This trial was conducted to compare the analgesic efficacy of administering variable‐frequency automated boluses at a rate proportional to the patient's needs with fixed continuous basal infusion in patient‐controlled epidural analgesia ( PCEA ) during labour and delivery. We recruited a total of 102 parturients in labour who were randomly assigned to receive either a novel PCEA with automated mandatory boluses of 5 ml administered once, twice, three or four times per hour depending on the history of the parturient's analgesic demands over the past hour (Automated bolus group), or a conventional PCEA with a basal infusion of 5 ml.h −1 (Infusion group). The incidence of breakthrough pain requiring supplementation by an anaesthetist was significantly lower in the Automated bolus group, three out of 51 (5.9%) compared with the Infusion group, 12 out of 51 (23.5%, p = 0.023). The time‐weighted mean ( SD ) hourly consumption of ropivacaine was similar in both groups, 10.0 (3.0) mg in the Automated bolus group vs 11.1 (3.2) mg in the Infusion group (p = 0.06). Parturients from the Automated bolus group reported higher satisfaction scores compared with those in the Infusion group, 96.5 (5.0) vs 89.2 (9.4), respectively (p < 0.001). There was no difference in the incidence of maternal side‐effects and obstetric and neonatal outcomes.