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

Background. Patient-controlled epidural analgesia (PCEA) isa relatively new method of maintaining labour analgesia. Therehave been many studies performed that have compared the efficacyof PCEA with continuous epidural infusion (CEI). The purposeof this systematic review is to compare the efficacy and safetyof 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 receivedanaesthetic interventions. Secondary outcomes included the doseof local anaesthetic, incidence of motor block, quality of analgesia,obstetric and safety outcomes. Where feasible, the data werecombined using meta-analytical techniques. For dichotomous data,the risk difference (RD) and 95% confidence intervals (CI) werecalculated. For continuous data, the weighted mean differences(WMD) were calculated. The differences were statistically significantwhen 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 alsoreceived less local anaesthetic (WMD, –3.92; 95% CI, –5.38to –2.42; P<00001) and less motor block (RD, 18%; 95%CI, 6–31%; P=0.003). Both methods were safe for motherand newborn. Conclusion. Patients who receive PCEA are less likely to requireanaesthetic interventions, require lower doses of local anaestheticand have less motor block than those who receive CEI. Futureresearch should be directed at determining differences in maternalsatisfaction and obstetric outcome. Br J Anaesth 2002; 89: 459–65