A COMPARATIVE STUDY OF PATIENT CONTROLLED EPIDURAL ANALGESIA VS CONTINUOUS EPIDURAL INFUSION IN LABOUR ANALGESIA USING ROPIVACAINE WITH FENTANYL
Dr. Sarvesh Srivastava, *Dr. Shibu Sasidharan, Brig Purn, Dr. Shishir Kumar, Dr. Babitha Shibu, Dr Shalendra Singh, Dr. Suneeta Singh
Background: Epidural analgesia is considered to be most effective tool for labour analgesia. Epidural drugs are administered either by bolus, continuous infusion or by patient controlled pumps. Historically, intermittent bolus dosing of local anaesthetic by the clinician (anaesthetist, nurse or midwife) was used. However this technique had a number of drawbacks including inconsistent analgesia, potential toxicity and concerns about sterility each time the clinician opened the system to administer a bolus. PCEA has not been broadly used for labour analgesia in India and there are no reports of the comparison between PCEA and CEI for Indian parturient using Ropivacaine with Fentanyl. So this study was selected and initiated to evaluate the difference between these two commonly employed labour analgesia techniques in Indian parturients undergoing labour at a tertiary care hospital. Methods: Epidural catheter of 16/18 G was inserted at L2-3 or L3-4 space, a 10 ml loading dose of study drugs solution (0.1% Ropivacaine + 2 mcg/ml of Fentanyl) was injected. After achieving initial pain relief, parturients were randomized in to PCEA or CEI group using closed envelop technique. Parturients in PCEA group received background continuous infusion of study drug solution at 6 ml/hr and patient controlled demand bolus of 6 ml with a lockout period of 20 minutes. Parturients in CEI group received continuous infusion of 10 ml/hr with a clinician initiated bolus of 7 ml on parturients request. Clinician initiated bolus were given after an interval of 30 minutes. Results: After the initial pain relief was achieved parturients were assessed for pain relief using VAS score. In both groups, VAS score was comparable during both stages of labour. Mean VAS score in PCEA group was 2.21 (S.D-0.602) and in CEI group was 2.27 (S.D-0.711) with P value of 0.664. The incidence of motor blockade as assessed using Bromage scale was comparable in both groups. One parturient in PCEA group experienced mild motor blockade (Grade II- assigned a score of 1 out of total 3), which regressed within two hours during labour only. The mean Bromage score in PCEA group was 0.008 (S.D-0.05) and in CEI group it was 0.000 (S.D-0.000) with P value of 0.322, signifying an insignificant difference. Conclusions: Findings of our study was consistent with those of previous studies that PCEA provides superior labour analgesia as compared to CEI in terms of decreased requirement of local anaesthetics and lesser intervention by Anaesthesiologist.
Keywords: Epidural Analgesia, Ropivacaine, PCEA, CEI.
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