PCEA for labor analgesia based on VAS scores: a prospective randomized controlled trial

To determine whether cervical dilatation during placement of epidural catheter for labor analgesia affects cesarean section rates or duration of labors. A prospective randomized controlled trial was conducted to investigate the efficacy of PCEA for labor analgesia based on VAS scores. One hundred and seventy-six ASA 1~2 parturients were randomly assigned to PCEA group (n=84) and control group (n=92) when their VAS pain scores were≥4 cm. In PCEA group, the parturients received bupivacaine 0.1％ with fentanyl 2 mag/m1. The PCEA setting was 8 ml for loading dose; 4 ml/h for background dose; 4 ml for PCA-demand dose; 15 min lockout interval and maximum dose per hour was 20 m1. In the control group, parturients received continuous midwife care. The duration of first 1abour, third 1abour and activity duration were similar in either group with cervical dilatation 0.05), but when the cervica1 dilatation was more than or equal to 4 cm during beginning of PCEA, the duration of second labour was longer in the PCEA group compared with that of the control group (98.1±15.8us 69.3±17.9, P 0.05), but the overall cesarean section rates was significantly higher when cervical dilatation was<4 cm as compared with≥4 cm during starting of PCEA (P<0.01). It is reasonable to start PCEA labor analgesia according to VAS scores, neither prolonged labor duration nor increased caesarean section rates are found even if the cervical dilatation is less than 4 cm when epidural labor analgesia starts.