Comparison of computer integrated patient controlled epidural analgesia vs. conventional patient controlled epidural analgesia for pain relief in labour

Abstract

Computer integrated‐patient controlled epidural analgesia (CI‐PCEA) is a novel drug delivery system. It automatically titrates the background infusion rate based on the individual parturient's need. In this randomised trial, we compared the local anaesthetic consumption by parturients using CI‐PCEA with demand only patient controlled epidural analgesia (PCEA) for labour analgesia. We recruited 40 parturients after approval by the ethics committee. Group PCEA (n = 20) received demand only PCEA. Group CI‐PCEA (n = 20) received a similar PCEA regimen but the computer integration titrated the background infusion to 5, 10 or 15 ml.h⁻¹ if the patient required one, two or three demand boluses, respectively, in the previous hour. The background infusion decreased by 5 ml.h⁻¹ if there was no demand bolus in the previous hour. The sample size was calculated to show equivalence in local anaesthetic used. The time weighted consumption of local anaesthetic was similar in both groups (mean difference 0.7 mg.h⁻¹, 95% confidence interval [CI: −2.5, 1.1]; p = 0.425). The CI‐PCEA group had higher maternal satisfaction scores: mean (SD) 93 (7) vs. 86 (11), p = 0.042. CI‐PCEA does not increase the use of local anaesthetic when compared with demand only PCEA but does increase patient satisfaction.