Comparison of intermittent epidural bolus, continuous epidural infusion and patient controlled-epidural analgesia during labor

The aim of the study was to compare efficacy and side-effects produced by t hree techniques of epidural analgesia during labor: intermittent bolus (IB) , continuous epidural infusion (CEI) and patient-controlled epidural analge sia (PCEA). One hundred and fifty parturients allocated randomly to three g roups received the same epidural solution of bupivacaine 0.125% with sufent anil 0.5 mu g/mL. In the first group (TB: n = 50) boluses were administered by the anesthesiologist and titrated to achieve adequate analgesia. In the second group (CEI: n = 50) an 8 mL/h continuous infusion was delivered. In the third group (PCEA: n = 50) parturients self-administered 5 mt boluses, with a lock-out interval of 10 min and a 4 h maximum dose of 50 mt. Insuff icient analgesia in the CEI and PCEA groups was treated by extra boluses of the same solution. Quality of analgesia measured by visual analog scale (V AS), and maternal satisfaction were comparable in the three groups. Hourly consumption of bupivacaine was lower in the IB group compared to the PCEA a nd CEI groups (P < 0.05). The number of extra boluses was significantly hig her in the CEI group compared to the PCEA group (32% vs, 12.5%). Motor bloc k was significantly more frequent in the CEI group compared to the IB group . The other side-effects were equally distributed in the three groups. We c oncluded that PCEA with bupivacaine and sufentanil is a valuable technique and a good alternative to the IB method, Compared to the CEI technique, PCE A. allows a decrease in local anesthetic consumption without impairing the quality of anesthesia. (C) 1999 Harcourt Publishers Ltd.