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BJA Advance Access published online on July 18, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael157
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted May 8, 2006

Clinical Investigation

Intermittent vs continuous administration of epidural ropivacaine with fentanyl for analgesia during labour{dagger}

P. D. W. Fettes 1 *, C. S. Moore 2, J. B. Whiteside 3, G. A. Mcleod 1, and J. A. W. Wildsmith 1

1 University Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
2 Present address: University Department of Anaesthesia, Edinburgh New Royal Infirmary, Edinburgh EH16 4SA, UK
3 Present address: Raigmore Hospital, Inverness IV2 3UJ, UK

* To whom correspondence should be addressed.
P. D. W. Fettes, E-mail: pdwfettes{at}doctors.org.uk


  Abstract

Background. Many years ago regular intermittent bolus administration of epidural local anaesthetic solution was recognized to produce more effective analgesia than continuous infusion, but only recently has the development of suitable pumps allowed the former technique's wider evaluation.

Methods. In this randomized, double-blind trial, 40 primigravid patients had a lumbar epidural catheter inserted, and plain ropivacaine 0.2% 15-20 ml was titrated until analgesia and bilateral sensory block to T10 were produced (time zero). Patients were then given either an infusion of ropivacaine 2 mg ml-1 with fentanyl 2 µg ml-1 at 10 ml h-1, or hourly boluses of 10 ml of the same solution. Pain, sensory block and motor block were measured frequently. If requested, additional 10 ml boluses of the study mixture were given for analgesia.

Results. There were no differences between the two groups in patient characteristics, obstetric/neonatal outcome, or in sensory or motor block. A total of 12 (60%) patients in the continuous group required one or more additional boluses compared with 4 (20%) patients in the intermittent group (95% CI 9.6-61.7%, P=0.02). Therefore the intermittent group received a lower total drug dose than the infusion group (P=0.02). Duration of uninterrupted analgesia (time to first rescue bolus) was longer in the intermittent group (P<0.02).

Conclusions. The intermittent group required fewer supplementary injections and less drug to maintain similar pain scores, sensory and motor block compared with the continuous group. This represents a more efficacious mode of analgesia.

Keywords: anaesthetic techniques, epidural; analgesia, obstetric; drug delivery, infusion; drug delivery, bolus; regional anaesthesia.
{dagger}Declaration of interest. P.D.W.F., C.S.M. and J.B.W. received salaries from AstraZeneca while working as research fellows at Ninewells Hospital, Dundee, UK.
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In regads to intermittent vs. continuous epidural analgesia during labor
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British Journal of Anaesthesia, 4 Jan 2007 [Full text]

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