Patient-controlled epidural analgesia with and without basal infusion using ropivacaine 0.15% and fentanyl 2γ/mL for labor analgesia: a prospective comparative randomized trial

BACKGROUND: Patient-controlled epidural analgesia (PCEA) is a common practice for labor pain relief. This study aimed to compare two different settings of a PCEA device using the same solution to obtain labor analgesia. METHODS: Fifty-two parturients were randomly allocated to receive ropivacaine 0.15% and fentanyl 2 gamma/mL via a PCEA device either as a background infusion of 5 mL/h plus 5 mL demand bolus doses with 10-minute lockout (group B/D, N.=26) or as only demand bolus doses of 5 mL with 10-minute lockout (group D, N.=26). The primary outcome was the total volume of local anesthetic administrated during labor, secondary outcomes included the analgesic efficacy and the effects on maternal and neonatal outcomes. RESULTS: No statistical difference was observed between the groups concerning demographic characteristics, duration of first and second stages of labor, administration of oxytocin and ephedrine, rescue doses, instrumental delivery, Brom-age Scale, maternal side effects and satisfaction, neonatal Apgar scores and pH. The total volume of local anesthetic was greater in group B/D compared to group D (P=0.015). A statistically significant difference was detected in VAS scores only at the end of the second stage (P=0.036) and at 60 minutes from the test dose administration (P=0.022) and with group D exhibited higher pain scores than group B/D. The incidence of breakthrough pain (VAS>4) was higher in group D compared with group B/D (P=0.035). CONCLUSIONS: The addition of background infusion plus PCEA demand bolus doses increased local anesthetic consumption and reduced breakthrough pain without affecting maternal satisfaction and neonatal outcomes.