Computer-integrated patient-controlled epidural analgesia: a preliminary study on a novel approach of providing pain relief in labour

Abstract

Introduction: The need for individualisation of analgesic therapy in labour cannot be overemphasised. We have devised a programme, based on a novel clinical algorithm, that converts a continuous infusion pump into a patient-controlled epidural analgesia (PCEA) pump that is responsive to the patient's needs by varying its rate of infusion.

Methods: In this double-blinded, controlled trial, 40 American Society of Anesthesiologists 1 patients were recruited to receive either a continuous infusion of 10 ml/hour (Continuous Epidural Infusion [CEI], n=20) or the computer-integrated (CI) regimen (CI-PCEA, n=20) to maintain epidural analgesia after successful induction of combined spinal analgesia during early labour. The proportion of patients who had delivered without a requirement for analgesic supplementation was the primary outcome measure.

Results: There was a significant difference in the incidence of breakthrough pain, i.e. the primary outcome measure (two in CI-PCEA versus eight in the CEI group, p-value is 0.027). There was a trend towards a longer duration before analgesic supplementation of analgesia was required after its induction with CI-PCEA than CEI (p-value is 0.06). We could not detect a difference in the total hourly consumption of epidural analgesics between the two groups.

Conclusion: Our study also showed that with the CI-PCEA programme, we were able to convert an ordinary infusion pump to one which analyses the patients' needs in the previous hour (based on analgesic demands) and automatically adjusts the basal infusion accordingly. CI-PCEA reduced the incidence of breakthrough pain without the evidence of increasing drug consumption when compared with CEI.