Patient-controlled epidural analgesia in labor does not always improve maternal satisfaction.

Title
Patient-controlled epidural analgesia in labor does not always improve maternal satisfaction.

Source
Acta Obstetricia et Gynecologica Scandinavica. 85(2):188-94, 2006.




BACKGROUND:

We investigated whether patient-controlled epidural analgesia in labor with bupivacaine and fentanyl provides more satisfaction to mothers than intermittent bolus epidural analgesia or patient-controlled epidural analgesia with plain bupivacaine.

METHODS:

Ninety mothers with term, uncomplicated pregnancies were randomized to receive intermittent bolus epidural analgesia (bupivacaine + fentanyl), patient-controlled epidural analgesia (bupivacaine + fentanyl), or patient-controlled epidural analgesia (bupivacaine). Pain during labor was evaluated with a visual analog scale. Obstetric and neonatal outcomes were recorded. After delivery, the mothers were given a questionnaire covering the following themes: experience of labor pain, feeling of control, fears and expectations associated with pregnancy/with delivery/with becoming a mother, as well as pain, physical condition and emotions after delivery. To elaborate on these answers, 30 mothers were further randomized to a semistructured interview, in which the same topics were discussed. The main outcome measure was maternal satisfaction.

RESULTS:

The intermittent bolus epidural analgesia group felt they could influence labor most, and in the interview they expressed most satisfaction. In this group, the total drug utilization was smallest (bupivacaine: comparing all groups, fentanyl: comparing the two fentanyl-receiving groups). No differences in pain occurred. Vomiting and pruritus were more common or more severe in the groups receiving fentanyl.

CONCLUSIONS:

We found no advantages for patient-controlled epidural analgesia over intermittent bolus epidural analgesia in terms of maternal satisfaction.