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combined spinal-epidural

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Chapter 15 - Remifentanil infusions and patient-controlled analgesia
- By P Foley, D Hill
Edited by Ian McConachie, University of Western Ontario
Book:

Controversies in Obstetric Anesthesia and Analgesia

Published online:

05 December 2011

Print publication:

17 November 2011, pp 186-195
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Summary

Epidurals are the most effective form of analgesia for the laboring parturient; however, pain relief has come with potential risks. Ongoing maintenance of analgesia may be with any number of techniques, which include but are not limited to continuous infusions, patient-controlled epidural analgesia (PCEA), and programmed intermittent epidural boluses. Ambulatory epidurals promote the retention of urinary function and reduce the risk of urinary catheterization during labor. PCEA has proven to be both safe and effective. The most consistent benefit appears to be decreased motor block with ropivacaine. Whether initiated or not with a combined spinal-epidural (CSE), ongoing analgesia with low-dose infusions or PCEAs confers these same benefits. Evidence suggests PCEA protocols that use a low-dose background infusion in combination with larger boluses with longer lockout intervals may be superior.