Patient-controlled epidural analgesia versus continuous infusion for labour analgesia: A meta-analysis

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dc.contributor.authorVan Der Vyver M.
dc.contributor.authorHalpern S.
dc.contributor.authorJoseph G.
dc.date.accessioned2011-05-15T16:15:45Z
dc.date.available2011-05-15T16:15:45Z
dc.date.issued2002
dc.description.abstractBackground. Patient-controlled epidural analgesia (PCEA) is a relatively new method of maintaining labour analgesia. There have been many studies performed that have compared the efficacy of PCEA with continuous epidural infusion (CEI). The purpose of this systematic review is to compare the efficacy and safety of PCEA and CEI. Methods. All randomized controlled trials that compared PCEA, without background infusion, with CEI were sought from the literature. These were rated for quality using a validated, five-point scale. The primary outcome was the number of patients who received anaesthetic interventions. Secondary outcomes included the dose of local anaesthetic, incidence of motor block, quality of analgesia, obstetric and safety outcomes. Where feasible, the data were combined using meta-analytical techniques. For dichotomous data, the risk difference (RD) and 95% confidence intervals (CI) were calculated. For continuous data, the weighted mean differences (WMD) were calculated. The differences were statistically significant when the 95% CI excluded 0. Results. Nine studies comprised of 640 patients were found. There were fewer anaesthetic interventions in the PCEA group (RD, 27%; 95% CI, 18-36%; P<0.00001). This group also received less local anaesthetic (WMD, -3.92; 95% CI, -5.38 to -2.42; P<00001) and less motor block (RD, 18%; 95% CI, 6-31 %; P=0.003). Both methods were safe for mother and newborn. Conclusion. Patients who receive PCEA are less likely to require anaesthetic interventions, require lower doses of local anaesthetic and have less motor block than those who receive CEI. Future research should be directed at determining differences in maternal satisfaction and obstetric outcome.
dc.description.versionArticle
dc.identifier.citationBritish Journal of Anaesthesia
dc.identifier.citation89
dc.identifier.citation3
dc.identifier.issn00070912
dc.identifier.other10.1093/bja/aef217
dc.identifier.urihttp://hdl.handle.net/10019.1/13473
dc.subjectbupivacaine
dc.subjectlocal anesthetic agent
dc.subjectropivacaine
dc.subjectarticle
dc.subjectclinical trial
dc.subjectconfidence interval
dc.subjectcontinuous infusion
dc.subjectcontrolled clinical trial
dc.subjectcontrolled study
dc.subjectdose response
dc.subjectdrug effect
dc.subjectdrug efficacy
dc.subjectdrug safety
dc.subjectepidural anesthesia
dc.subjectfemale
dc.subjecthuman
dc.subjecthypotension
dc.subjectintermethod comparison
dc.subjectmajor clinical study
dc.subjectmeta analysis
dc.subjectmother
dc.subjectmotor dysfunction
dc.subjectmotor nerve block
dc.subjectmuscle weakness
dc.subjectnausea
dc.subjectnewborn
dc.subjectobstetric analgesia
dc.subjectpatient controlled analgesia
dc.subjectpatient satisfaction
dc.subjectpriority journal
dc.subjectpruritus
dc.subjectrandomized controlled trial
dc.subjectrating scale
dc.subjectrisk assessment
dc.subjectstatistical analysis
dc.subjecttreatment outcome
dc.subjectvalidation process
dc.subjectAnalgesia, Epidural
dc.subjectAnalgesia, Obstetrical
dc.subjectAnalgesia, Patient-Controlled
dc.subjectAnesthesia, Obstetrical
dc.subjectAnesthetics, Local
dc.subjectFemale
dc.subjectHumans
dc.subjectInfusions, Parenteral
dc.subjectLabor, Obstetric
dc.subjectMuscle Weakness
dc.subjectPain Measurement
dc.subjectPatient Satisfaction
dc.subjectPregnancy
dc.subjectRandomized Controlled Trials
dc.subjectTreatment Outcome
dc.titlePatient-controlled epidural analgesia versus continuous infusion for labour analgesia: A meta-analysis
dc.typeArticle
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