CONTINUOUS EXTRADURAL ANALGESIA IN LABOUR: Comparison Between "On Demand" and Regular "Top-up" Injections

In a prospective comparative study 240 patients received extraduralbupivacaine, either by regular timed injections or "on demand",for pain relief during the first stage of labour. Three concentrationsof bupivacaine were used (0.5%, 0.375% and 0.25%). Quality andcontinuity of analgesia, motor blockade, spread of sensory blockade,cardiovascular changes, fetal outcome and maternal sequelaewere recorded. Overall, the analgesia provided by regular top-upinjections was superior to the on demand technique, especiallywhen 0.375% bupivacaine was used. This improved analgesia wasachieved without causing an increased incidence of operativedeliveries or deleterious sequelae, with respect to the motheror the neonate.