Comparison of computer-integrated patient-controlled epidural analgesia with no initial basal infusion versus moderate basal infusion for labor and delivery: A randomized controlled trial

Ban Leong Sng, David Woo, Wan Ling Leong, Hao Wang, Pryseley Nkouibert Assam, Alex Th Sia, Ban Leong Sng, David Woo, Wan Ling Leong, Hao Wang, Pryseley Nkouibert Assam, Alex Th Sia

Abstract

Background and aims: Computer-integrated patient-controlled epidural analgesia (CIPCEA) is a novel epidural drug delivery system. It automatically adjusts the basal infusion based on the individual's need for analgesia as labor progresses.

Materials and methods: This study compared the time-weighted local anesthetic (LA) consumption by comparing parturients using CIPCEA with no initial basal infusion (CIPCEA0) with CIPCEA with initial moderate basal infusion of 5 ml/H (CIPCEA5). We recruited 76 subjects after ethics approval. The computer integration of CIPCEA titrate the basal infusion to 5, 10, 15, or 20 ml/H if the parturient required respectively, one, two, three, or four patient demands in the previous hour. The basal infusion reduced by 5 ml/H if there was no demand in the previous hour. The sample size was calculated to show equivalence in LA consumption.

Results: The time-weighted LA consumption between both groups were similar with CIPCEA0 group (mean [standard deviation (SD)] 8.9 [3.5] mg/H) compared to the CIPCEA5 group (mean [SD] 9.9 [3.5] mg/H), P = 0.080. Both groups had a similar incidence of breakthrough pain, duration of the second stage, mode of delivery, and patient satisfaction. However, more subjects in the CIPCEA0 group required patient self-bolus. There were no differences in fetal outcomes.

Discussion: Both CIPCEA regimens had similar time-weighted LA consumption and initial moderate basal infusion with CIPCEA may not be required.

Keywords: Anesthesia; epidural; obstetrical.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Computer-integrated patient controlled epidural analgesia with no initial basal infusion (CIPCEA0)
Figure 2
Figure 2
Computer-integrated patient controlled epidural analgesia with initial moderate basal infusion 5 ml/H (CIPCEA5)
Figure 3
Figure 3
Cumulative incidence of breakthrough pain from initiation of epidural analgesia

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