Patient-Controlled Epidural Anesthesia (PCEA)
Tuesday, September 27, 2011 at 10:47AM
By Emjaybee
So in checking up on the blog Stand and Deliver, I came across a reference to the practice of Patient-Controlled Epidural Anesthesia (PCEA), and realized that I had never met a woman who had used it during her labor.
This article describes PCEA as used in one hospital and the results as observed there:
A drawback of traditional continuous epidural infusion is that patients don’t receive additional analgesia until they complain of pain, creating a gap between pain perception and treatment. This is especially detrimental during labor, when a patient’s analgesia requirements may increase progressively. In contrast, PCEA provides continuous epidural infusion and lets the patient self-administer bolus doses to manage her own pain.
Research by Stienstra showed that PCEA reduced patients’ hourly dose requirements compared with patients receiving traditional continuous epidural infusions. Laboring patients with PCEA also benefited from feeling in control of their own pain management.
Similarly, a meta-analysis by van der Vyver, et al., showed that laboring patients who received PCEA were less likely to require anesthetic interventions, required fewer doses of local anesthetic, and had less motor block.
A literature search revealed that little research has been done comparing patient satisfaction with the two methods. After trying PCEA with our patients, we hoped to contribute to this area of research with our patient-satisfaction survey.
All of that sounds good, but we’d like to hear from anyone who’s used it, or observed it; do you think it makes a material difference in the experience of pain in labor, good or bad? Is it really preferable to a traditional epidural? Does it have more risks? Are many hospitals even bothering with it? Are hospitals using it as a “draw,” like laboring tubs, etc?
Reader Comments (16)
I had this for my first birth (5 years ago now, how did THAT happen?). I'm actually surprised to hear that it's not the standard- I'm not sure how to weigh in on it since I have no experience with the alternative. When it was first put in, I did need the anesthesiologist to come back since there was a window, but other than that I was able to manage the pain just fine, pressing the button when I needed a little more relief. Anyway, all the evidence I've seen supports PCA over other types of analgesia in pretty much all pain management situations; it's not shocking that's the case for labor as well.
The idea of having to summon someone else whenever your pain level increases or starts to breakthrough, and then wait for them to get there, and then have them decide how much to give you (either too little, or more than you actually need so they're certain you're all set and they won't need to come back 15 minutes later).... that seems like it would suck. There are lock-outs so that you can't overdose yourself. I'm having a hard time seeing any reason anyone would still be using a non patient-controlled epidural.
I was given a PCEA. I didn't realize it till later, but they were asking me if I was feeling pain, and if so, to push the button they gave me. I remember only pushing it once, at the very end of pushing for two and a half hours. I started to feel pain in my buttocks, and it relieved it. I was planning a natural birth with no pain meds, but I ended up finding that I had a scarred cervix, which turned out to be excruciating. The meds helped me have my son vaginally. Otherwise, I would have opted for a c-section, even though I would have hated it. I have never felt more relief than that day and getting an epidural. Not my first choice, but who plans for horrific pain and a rigid, scarred cervix?
Kate
idreamloudly.com
By "patient-controlled," does that mean 100% patient-controlled? At the hospitals here, the moms get a continuous infusion AND a button to push. Any time the moms complain of pain if the epidural isn't placed correctly or if it just isn't working, period, the first thing everyone says is "Are you pushing your button? It won't completely stop the pain if you don't keep pushing the button." So I guess it is PCEA in some respects, but there is also a continuous infusion.
I had a PCEA with my first birth. Hospitals where I currently life do not offer them. I had my second and plan to have the rest from now on using Hypnobabies and no drugs, I think I would prefer the PCEA over one that is not like that. My midwife wanted me to notify her when I pushed the button because often an increase in pain signifies that labor is progressing, so she wanted to be aware of that, but it was nice to just be able to push it and not have to have them call someone to adjust the dose if it needed it. It also allowed them to give me a pretty low dose to start with, and I chose not to push the button when I started feeling stuff again when it was clear pushing was getting close, so I was able to feel a little to help me push. I hadn't wanted to birth that way, but under the circumstances, it was the best thing to do, I have no complaints about how things with the anesthesia went. Having that control is a good thing for the psyche. I also have a friend who had her first with PCEA in another state and had the traditional epi with her second, and she preferred the PCEA. I think most women, whether the epidural was plan A or plan B, would prefer a patient-controlled one.
A friend of mine had one of these for her VBAC 4 weeks ago. She had a great experience.
I'm an L and D RN at a major hospital and we exclusively use PCEA and have for at least 5 years. I really like it--I think it allows us to keep our basal rate lower, which decreases the overall "over numbing" of patients. It also allows us to direct the pain control better (turn a patient one way or another and then give a bolus). I think it's also great for people who want to feel more---they can really decide that and it really helps with pushing.
My partners sister had PCEA at our local hospital and it is "patient controlled" but you can only push the button every fifteen mins. and she told me that she was "high as hell and juiced up" as if she had taken the drugs to get high. Iv actually heard a few woman describe that even non PCEA has gotten them high in the mental sense. I have no idea what its like to be under EA because I never recieved one.
Several times. However, in my experience, the anesthisiologist forgets to tell the mom about the button about half the time. Then there is a rush to get back on top of the pain. But as epidurals go, I think they are pretty neat!
I had an experience like Brittany. I had an epidural and was handed a button to push if I wanted "more". So I think they must have started at a low dose, and I never pushed the button (or wanted to). It wasn't a conscious choice *not* to push the button; I just didn't need it. I could feel some sensation, but no pain. I felt my baby being born like pressure, but nothing else. (And thank god too because I had a really bad tear and I''m glad I didn't have to go through a bunch of lidocaine, etc on my sore perineum.) I had a tingling sensation in my legs and could move them a tiny bit, which made it easier for the nurses and doula to help me move around. Yes, they helped position me into a squat for every contraction (there was a squat bar, so I only needed help getting up) for hours until I was too tired. I was sorry that I had an epidural in some ways, but it was a great experience as such. I'm so glad I wasn't given a high dose, though.
At Magee Hospital in Pittsburgh, I have *only* observed PCEA. It really does seem to work out better for mom. Shorter pushing times than at the births where I've seen the standard epi and mom can feel as much/little as she wants for the most part. Unfortunately, I still saw many epidurals that were patchy-overall or lowered the mom's BP so much that she had to have meds for that. And it still seems to require pit to keep the ctx going for most of the moms, too.
But overall, I feel very positive about this option and talk to my students about it when we discuss epidural anesthesia.
We only have PCEA where I am at as well. There is a low dose continuous infusion and mum can top herself up whenever she likes, with a lock-out. I can't imagine doing it any other way - it would be awful to have to wait for someone from anasthesia to come everytime!
Oh my Lord I loved my epidural button. I hammered that thing through pushing- my bladder was distended, and my tailbone has been broken three times so it's bent at an angle that makes it EXTREMELY painful once the baby starts to push past it. Of course, being in the lithotomy position in the first place probably had something to do with it. All the same, since I'd already gotten the epidural, I liked my button.
I had a terrible experience with PCE, which is standard in Australia. The line was run before 4 cm and before active labour so as to avoid having to try and put in the epidural during hard labour. However, the anes. put in a test dose w/o permission and expressly against my wishes, and then the midwives came in and pushed the button **for** me stating that if the test dose wore off then the epidural would not work any more. They would not desist. I asked for the epidural to be removed and was met active resistance. I was numb for the entire labour and could not move my legs, and had a cesarean for "Failure to Progress".
PCE is a great concept but it can be abused. A complaint to the medical board and hospital was totally brushed off. I would never agree to an epidural again unless I knew I was going in for a section. Peace.
This sounds like a really interesting option, and I've never heard about it before. I had a regular epidural, and I couldn't feel anything at all -- I kept saying that I couldn't feel anything at all, but nobody but me registered that as a problem. When pushing was ineffective, I asked if it could be turned down, or off, and I was told "no."
I used PCEA with my birth a month ago - I had intended to not use any pain medication, but wound up being induced 36 hours after SROM and the pain was insane. I got different instructions from different nurses. One said if I had to press the button more than twice an hour I should tell someone and they'd turn up the continuous drip. Another nurse said I should push it as much as I wanted and not worry about it. In the end I did have to ask to have the drip turned up because the boluses weren't taking care of the pain. I hated the epidural and all that went with it (the fluids, the immobility, the numbness), but I appreciated having some control over the level of medication.
I too was given the PCEA, at the time I was 20 years old and giving birth to my first and only son who weighed 8'6 at birth. I had no knowledge that there was anything like this method of pain reduction so when the nurses showed me there was a push button involved i immediately thought to strategize my doses up until I reached 10 cm. I rmbr not wanted to press the button until I reached 7 cm..once i pressed the button i felt a little better but couldnt really tell because I progressed to 10 cm about 45 min later.Once reaching 10 cm i began pressing because I knew it would b time to push any minute. To make a long story short I had a vaginal birth bringing my son into this world 5 days after his due date. I am now 22 and my son is 14 mons and i am experiencing excrusiating pain in my back and legs. The first time i went to the ER the physician saw aurtheritis clouded around my spine, since then I have been experiencing pain in my lower legs and thighs.It was ok to have controll over my pain in labor but I am a young mother who can not work to take care of my child because of new epidural methods. So to every women that is expecting a child or children,Please research epidurals before giving birth, just because this method is new does not mean its for everyone..thank you have a blessed life