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

BACKGROUND: 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.