• Mhamed Sami Mebazaa, Issam Tanoubi, Tahar Mestiri, Mohamed Faouzi Gara, and Mohamed Salah Ben Ammar.
• Service d'Anesthésie Réanimation, Hôpital Mongi Slim, La Marsa.
• Tunis Med. 2008 Jun 1;86(6):540-5.

BackgroundEpidural analgesia is the most effective for the control of pain during labor but irregularity of analgesia, toxicity of local anesthetics (LA) and driving block are the major limits of the modalities of maintenance.AimThe purpose of this work was to assess the effectiveness and adverse effects of adaptations offered with Patient Controlled Epidural Analgesia (PCEA).Methods40 mono-foetal parturients were randomized in two groups: 0.1% bupivacaine continuous drip associated to fentanyl 2 lg/mL (CP-group) or same products administrated in PCEA. Evaluation of analgesia, driving and sensory block allows adapting the outputs of drip.ResultsConsumption schedule in LA was of 7.5+/-2 mL/h in the CP-group and 3.5+/-1.5 mL/h in PCEA-group (p < 0.05). Consumption accumulated by LA is reduced by 35 % from the very beginning and 43% a 4-th hour (p<0.05). Incidence of the driving block was of 11 cases in CP-group against 4 in PCEA-group per first hour and of 13 cases against 3 per second hour (p<0.001). 50% of clinical obstetric interventions were brought together in the CP-group against 5 % in the PCEA-group (p=0.013). Incidence of side effects is comparable.ConclusionBesides the perfect analgesia, PCEA offers a psychic independence which explains comfort and maternal satisfaction. Accumulation of LA entails a driving block involved in the change of dynamics of the labor. Incidence of clinical obstetric interventions is the major observation of our study.

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