Patient‐controlled epidural technique improves analgesia for labor but increases cesarean delivery rate compared with the intermittent bolus technique

Halonen, P.; Sarvela, J.; Saisto, Terhi; Soikkeli, A.; Halmesmäki, Erja; Korttila, K.

doi:10.1111/j.0001-5172.2004.00413.x

Cited by 13 publications

(8 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Quality of pain relief was similar between the two modalities, except in the study by Paech et al (143): ITU resulted in higher maximal pain scores. Also in the study by Halonen et al PCEA produced better analgesia (141). Gambling et al reported increased satisfaction scores with PCEA as compared to ITU, but other authors could not confirm these results (144).…”

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Intermitmentioning

confidence: 94%

“…Two studies demonstrate a negative effect on obstetric outcome with PCEA (141,143). Paech et al observed a prolonged second stage of labour, while Halonen et al noted more Caesarean sections as well as a longer second stage (141,143).…”

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Intermitmentioning

confidence: 99%

“…Several studies compared PCEA with ITU techniques of maintaining epidural analgesia during labour (135,137,(140)(141)(142)(143)(144). Quality of pain relief was similar between the two modalities, except in the study by Paech et al (143): ITU resulted in higher maximal pain scores.…”

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Intermitmentioning

confidence: 99%

“…Gambling et al reported increased satisfaction scores with PCEA as compared to ITU, but other authors could not confirm these results (144). In terms of local anaesthetic consumption reported results are conflicting: most studies show no difference, while some report an increased consumption with PCEA and others report a decreased consumption with PCEA (137,(141)(142)(143). Two studies demonstrate a negative effect on obstetric outcome with PCEA (141,143).…”

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Intermitmentioning

confidence: 99%

“…In terms of local anaesthetic consumption reported results are conflicting: most studies show no difference, while some report an increased consumption with PCEA and others report a decreased consumption with PCEA (137,(141)(142)(143). Two studies demonstrate a negative effect on obstetric outcome with PCEA (141,143). Paech et al observed a prolonged second stage of labour, while Halonen et al noted more Caesarean sections as well as a longer second stage (141,143).…”

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Intermitmentioning

confidence: 99%

See 4 more Smart Citations

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Velde

2009

Revista Española de Anestesiología y Reanimación

View full text Add to dashboard Cite

Most authors would agree that central neuraxial analgesia is the best form to manage labor pain. When neuraxial analgesia is administered to the parturient in labor, different management choices must be made by theanesthetist: how will we initiate analgesia, how will analgesia be maintained, which local anesthetic will we use for neuraxial analgesia and which adjuvant drugs will we combine? The present manuscript tries to review the literature to answer these questions. INITIATION OF NEURAXIAL ANALGESIAA lmost two decades have passed since French and American trials evaluated the use of spinal opioids during labor and since European randomized trials compared conventional epidural analgesia with combined spinal epidural (CSE) analgesia (1-3). CSE analgesia has gained worldwide acceptance and is becoming increasingly popular as the method of choice for labor pain relief (4-9). Obstetric anesthetists are divided when questioned on the place of CSE in labor analgesia. Whilst some authors feel it should be the technique of choice, others reserve CSE for certain indications (10-15). Recently, Simmons et al. published a Cochrane review concluding that CSE offers little benefit as compared to conventional epidural analgesia (16). However, the authors of this meta-analysis did acknowledge that CSE produced faster analgesia, resulted in less need for rescue analgesia and was associated with less urinary retention. Apart from a slight increase in the incidence of pruritus, these beneficial effects were not associated with more complications. The three demonstrated benefits of CSE are sufficient to promotes it's use if the side-effect profile remains unaltered. Furthermore it must be stressed that this Cochrane review can be criticized. Firstly, a number of well performed studies were excluded from analysis because of uncertain reasons. Inclusion of these well performed studies into the analysis might have affected the overall conclusions. Secondly, a number of outcomes were not considered in the analysis such as one-sided analgesia, epidural catheter reliability, anesthetist intervention rate, local anesthetic consumption and the occurrence of fetal heart abnormalities. Finally, very different types of CSE were used in the various studies. They were all considered to be a generic procedure and analyzed combined.Arguably the most obvious advantage of the CSE technique is the rapid and spectacular onset of effective analgesia with minute concentrations of local anesthetics with or without adjuvant drugs (16). Consistently, effective labor analgesia is accomplished within 4-6 minutes

show abstract

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Intermitmentioning

confidence: 94%

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Intermitmentioning

confidence: 99%

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Intermitmentioning

confidence: 99%

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Intermitmentioning

confidence: 99%

Section: Patient Controlled Epidural Analgesia (Pcea) Versus Intermitmentioning

confidence: 99%

See 3 more Smart Citations

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Velde

2009

Revista Española de Anestesiología y Reanimación

View full text Add to dashboard Cite

show abstract

Update on best available options in obstetrics anaesthesia: perinatal outcomes, side effects and maternal satisfaction. Fifteen years systematic literature review

Gizzo

Noventa

Fagherazzi

et al. 2014

Arch Gynecol Obstet

View full text Add to dashboard Cite

No significant differences occurred among all the available administration schemes of neuraxial analgesia. In absence of obstetrical contraindication, neuraxial analgesia has to be considered as the gold standard in obtaining maternal pain relief during labour. The options available in the administration of analgesia should be known and evaluated together by both gynaecologists and anaesthesiologists to choose the best personalized scheme and obtain the best women satisfaction. Since it is difficult to identify comparable circumstances during labour, it is complicate to standardize drugs schemes and their combinations.

show abstract

Obstetric Anesthesia

Hawkins¹,

Goetzl²,

Chestnut³

2007

Obstetrics: Normal and Problem Pregnancies

View full text Add to dashboard Cite

Patient‐controlled epidural technique improves analgesia for labor but increases cesarean delivery rate compared with the intermittent bolus technique

Abstract: The PCEA technique provided better pain relief. This was associated with higher bupivacaine consumption, prolongation of the second stage of labor, and an increased rate of cesarean section.

Cited by 13 publications

References 17 publications

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Modern neuraxial labor analgesia: options for initiation, maintenance and drug selection

Update on best available options in obstetrics anaesthesia: perinatal outcomes, side effects and maternal satisfaction. Fifteen years systematic literature review

Obstetric Anesthesia

Contact Info

Product

Resources

About