A comparison of patient-controlled epidural pethidine vs. nurse-administered epidural pethidine for analgesia after caesarean section

Abstract

Patient-controlled epidural analgesia with pethidine for post-caesarean section patients has been shown to be efficacious. However, no studies to date have compared it with intermittent nurse-administered epidural pethidine. The aim of this study was to compare the analgesia efficacy, pethidine requirement, side effects, and nurses’ and patients’ satisfaction with these two techniques in postcaesarean section patients. After obtaining informed patient consent, we recruited 34 patients undergoing elective lower-segment caesarean section. A combined spinal epidural technique was used to provide anesthesia for all patients, and 50 mg pethidine was given epidurally at the end of the operation. Patients were assigned to two groups: group P (n = 17) received patient-controlled epidural analgesia with pethidine (25 mg of five mg/ml solution, lockout of 10 minutes and maximum dose of 150 mg/four hours), and group N (n = 17) received nurseadministered epidural pethidine (bolus of 50 mg and maximum dose of 50 mg/two hours) when required. We collected data at six, 12, 24, 36, and 48 hours following initiation of anesthesia. Visual analogue pain scores (median) were lower in group P than in group N, both on movement and at rest, at six, 12, 24, 36, and 48 hours postoperatively (p < 0.05). Total pethidine consumption (median) and frequency of side effects were similar in both groups. Patients in group P exhibited a trend toward earlier return to activities of daily living and care for the newborn; however, this did not reach statistical significance, and there was no difference in maternal satisfaction between the two groups. Satisfaction scores of nurses caring for patients in group P were higher than for those in group N (median 100 mm, interquartile range [IQR] 90 to 100, vs. median 90 mm, IQR 80 to 90, p < 0.05). Patient-controlled epidural analgesia with pethidine improved patients’ pain scores after caesarean section when compared with intermittent nurse-administered epidural pethidine. Regarding the mode of delivery of postoperative analgesia, we noted a higher satisfaction score among nurses caring for group P than among those caring for group N.