Patient-Controlled Epidural Anesthesia (PCEA)

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By Emjaybee

 

So in checking up on the blog Stand and Deliver, I came across a reference to the practice of Patient-Controlled Epidural Anesthesia (PCEA), and realized that I had never met a woman who had used it during her labor.

This article describes PCEA as used in one hospital and the results as observed there:

A drawback of traditional continuous epidural infusion is that patients don’t receive additional analgesia until they complain of pain, creating a gap between pain perception and treatment. This is especially detrimental during labor, when a patient’s analgesia requirements may increase progressively. In contrast, PCEA provides continuous epidural infusion and lets the patient self-administer bolus doses to manage her own pain.

Research by Stienstra showed that PCEA reduced patients’ hourly dose requirements compared with patients receiving traditional continuous epidural infusions. Laboring patients with PCEA also benefited from feeling in control of their own pain management.

Similarly, a meta-analysis by van der Vyver, et al., showed that laboring patients who received PCEA were less likely to require anesthetic interventions, required fewer doses of local anesthetic, and had less motor block.

A literature search revealed that little research has been done comparing patient satisfaction with the two methods. After trying PCEA with our patients, we hoped to contribute to this area of research with our patient-satisfaction survey.

All of that sounds good, but we’d like to hear from anyone who’s used it, or observed it; do you think it makes a material difference in the experience of pain in labor, good or bad? Is it really preferable to a traditional epidural? Does it have more risks? Are many hospitals even bothering with it? Are hospitals using it as a “draw,” like laboring tubs, etc?