Comparative Study of the Combination of Different Modes of Administration of Local Anesthetics in Labor Analgesia
Condition: Labor Epidural Analgesia
MeSH terms: Agnosia
Study type: Observational

Summary: 
      The investigators have design an observational study to know the anesthetic consumption in
      terms of rescue analgesia (Patient Controlled Epidural Analgesia (PCEA) and manual boluses)
      of the combination of different modes of administration of local anesthetic in the epidural
      space during labor analgesia offered by the new version of the CADD® infusion pump.

      Also in this pump the anesthetic can be administered across a system of standard flow
      (40-250ml/h) or of high flow (40-500ml/h), what according to studies can influence the
      diffusion epidural of the anesthetic and therefore the level of sensitive blockade.
    

Detailed description: 
      The study is designed with healthy patients, first-time mothers, in childbearing dynamics,
      term pregnancy and nullipary. The epidural technique was performed with dose test of 3ml of
      bupivacaína 0,25 % with vasoconstrictor and a manual bolus of 0,1ml/Kg of ropivacaína 0,2%
      with fentanilo 5ug/ml.

      As soon as the informed consent about the epidural anesthesia was signed, the patient was
      informed of the possibility of taking part in the study and there is offered him the sheet of
      information of the patient. So in one group they were administered Programed Intermittent
      Epidural Boluses (PIEB) and in other group continuous Epidural Infusion (IC) plus PIEB
      according to the usual clinical practice of each anesthesiologist. In both cases the
      perfusion was of ropivacaína 0,1 % more fentanilo 2ug/ml, so that in the first group it was
      administered PIEB of 10ml every hour and in the second group a continuous infusion to 3ml/h
      plus PIEB of 7ml every hour. Also if during the period of dilatation an AVE (Analogical
      Visual Escale) greater than or equal to 4 appeared (inadequate analgesia) the patient could
      administer a 5ml PCEA bolus of the same solution (interval of closing of 20min and maximum
      dose for hour of 15ml), as it is done in according to the usual clinical practice. And if
      after two boluses of PCEA the analgesia was still ineffective a clinical bolus of 4ml of
      lidocaína to 1 % was administered by the anesthesiologist.

      In addition, in the group that was administered only PIEB, the standard infusion system was
      compared with the high-flow infusion system.

      In all patients it was evaluated and noted on the epidural record sheet the intensity of the
      pain as the analogical visual scale (AVE), the grade of motor blockade as the modified scale
      of Bromage and the sensitive level in different periods of time. Also registered the total
      doses of anesthetic, the way of the childbearing finishes, the Apgar of the newborn, the
      grade of maternal satisfaction and the side effects. Also through the software of the pump it
      was verified if the patient had been administered rescue analgesia (PCEA or clinical
      boluses).
    

Intervention name(s): IC+PIEB+PCEA high flow; PIEB+PCEA high flow; PIEB+PCEA standar flow
Intervention type(s): Device; Device; Device
Intervention description(s): Ropivacaina 0,1 % is used with fentanilo 2ug/ml Also if during the dilation period a greater or equal AVE appears to 4 (inadequate analgesia) the patient can be administered a bolus of PCEA of the same solution.
If the patient is administered PCEA, the programed intermittent epidural bolus is delayed automatically 20 minutes with regard to the time in which it would have to be administrated.
If after two bolus of PCEA the analgesia keeps on being ineffective a clinical bolus is administered by the anaesthetist of 4ml of lidocaína to 1 %.
This intervention is included in the clinical practice routine; Ropivacaina 0,1 % is used with fentanilo 2ug/ml Also if during the dilation period a greater or equal AVE appears to 4 (inadequate analgesia) the patient can be administered a bolus of PCEA of the same solution.
If the patient is administered PCEA, the programed intermittent epidural bolus is delayed automatically 20 minutes with regard to the time in which it would have to be administrated.
If after two bolus of PCEA the analgesia keeps on being ineffective a clinical bolus is administered by the anaesthetist of 4ml of lidocaína to 1 %.
In the group of pure boluses 10ml / h of perfusion will be administered through the high flow and standard flow infusion system, and the maximum sensory level achieved will be compared.
This intervention is included in the clinical practice routine; Ropivacaina 0,1 % is used with fentanilo 2ug/ml Also if during the dilation period a greater or equal AVE appears to 4 (inadequate analgesia) the patient can be administered a bolus of PCEA of the same solution.
If the patient is administered PCEA, the programed intermittent epidural bolus is delayed automatically 20 minutes with regard to the time in which it would have to be administrated.
If after two bolus of PCEA the analgesia keeps on being ineffective a clinical bolus is administered by the anaesthetist of 4ml of lidocaína to 1 %.
In the group of pure boluses 10ml / h of perfusion will be administered through the high flow and standard flow infusion system, and the maximum sensory level achieved will be compared.
This intervention is included in the clinical practice routine
Observational model: Other
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The study will be realized in women in work of labor who come our hospital and who after
        being valued by the team of obstetrics are in favorable active period for the achievement
        of the technique epidural previous informed consent.
      
Keywords: epidural local anesthetic; epidural analgesia; analgesia labor