A randomized comparison of a five-minute versus fifteen-minute lockout interval for PCEA during labor

A double-blind randomized controlled trial of patient-controlled epidural analgesia with or without a background infusion following initial spinal analgesia for labor pain

“…[1][2][3][4][5][6][7] In addition, maternal satisfaction may be higher with PCEA than with the techniques not involving patient participation. However, an ideal protocol for delivery of PCEA has not been agreed upon, 8,9 with the effectiveness and advisability of a continuous background infusion (CBI) being a key issue. Some investigators have questioned the advantages of a CBI, [10][11][12] suggesting that omitting the infusion would reduce the overall dose of analgesic agents used during labor.…”

“Ultra-light” patient-controlled epidural analgesia during labor: effects of varying regimens on analgesia and physician workload

“…In contrast to a previous study, shorter PCEA lockout times did not reduce the need for rescue boluses. 12 Because of the patient-controlled bolus function with the PCEA technique, these dilute concentrations were not labor-intensive nor were they associated with increased anesthetic "call-back" as suggested by the authors of the COMET study. 15 The CO-MET study showed that traditional solutions (bupivacaine 0.25%) had fewer physician interventions compared to low dose (bupivacaine 0.1%) continuous labor epidural infusions, although assisted vaginal delivery was more common with the traditional solution.…”

“…7 Potential benefits with PCEA may depend on the type and concentrations of drugs used, the bolus dose and lockout interval selected, and the use of a continuous background infusion. [8][9][10][11][12] The ideal PCEA settings and local anesthetic solutions for labor analgesia have not yet been established. Bernard et al 8 found that increasing the bolus size from 4 mL (lockout 8 min) to 12 mL (lockout 25 min) improved parturient satisfaction.…”

“…Shorter lockout times (5 min vs 15 min) may reduce the need for rescue boluses with 0.125% bupivacaine with fentanyl. 12 However, larger volumes of more dilute local anesthetic appear more effective than smaller volumes of higher concentration. 13,14 No previous studies have evaluated PCEA settings of the more dilute local anesthetic solutions (e.g., bupivacaine 60.0625%).…”

“…We used bolus and lockout settings based on our standard labor PCEA practice and adapted from previous PCEA regimen studies. 8,12 We selected a continuous background infusion of approximately one third the maximum hourly demand dose as recommended by Ferrante et al 10 This study was designed to evaluate several "ultralight" PCEA plus background CI regimens to determine the optimum PCEA settings for labor analgesia using bupivacaine 0.0625% with sufentanil.…”