Patient-controlled epidurals may mean less anesthesia, fewer forceps deliveries

Allowing women to control epidural anesthesia during labor reduces the amount of medication used by 30% and may decrease forceps deliveries, researchers at Long Beach Memorial Medical Center, California, report.

Their study compared 270 primigravida women who were randomly stratified into 3 groups: continuous infusion of the standard dose of epidural anesthetic, continuous infusion plus a patient-controlled option, and patient-controlled anesthesia alone. All groups received an initial injection of 2 mg bupivicaine/20 μg fentanyl, followed by a maintenance epidural infusion of 0.1% bupivicaine/2 μg/mL of fentanyl. The first 2 groups used an average of 74.9 mg and 95.9 mg of anesthesia, respectively, during labor; the patient-controlled group used an average of 52.8 mg. Duration of labor and rate of cesarean delivery did not differ among the 3 groups.

Those women who controlled their anesthesia “were basically as comfortable as woman on a continuous dose, and there was a 30% reduction in the amount of anesthesia used,” says lead author Michael Haydon, MD. The study also indicated a trend toward fewer instrument-assisted deliveries in the patient-controlled anesthesia group.

Lower limb strength and urge to push did not differ with the method of anesthesia delivery, although women who used patient-controlled anesthesia reported slightly more pain during the pushing stage of labor. Allowing women to administer more medication more often during that stage would likely reduce the pain, the authors note. Overall patient satisfaction was similar across the 3 groups.

The researchers presented their results on February 10 at the 31st annual meeting of the Society for Maternal-Fetal Medicine in San Francisco.