A Comparative Study of Continuous and Intermittent Epidural Analgesia for Labor and Delivery

Sixty healthy primigravidae at greater than 37 weeks' gestation had a lumbar epidural catheter placed when labor was well established. Following routine precautions, all patients received an initial injection of 12 ml of 0.25% bupivacaine. Group A patients then received 8 ml of 0.25% bupivacaine per hour by continuous pump infusion and Group B patients received the same dose on a prn basis. Sensory and motor blocks were assessed hourly and unblocked segments noted. All parturients labored in the lateral position and the adequacy of perineal anesthesia at delivery, as well as the need for instrumental delivery, was noted. A visual analog scale was used for pain assessment before the epidural, one hour after the epidural and in the recovery area. 24 hours later, assessment was made of patient satisfaction. The nature, duration and outcome of labor and the neonate were determined. In 6 patients from each group maternal and fetal cord levels of bupivacaine were determined.