Walking epidural with low-dose levobupivacaine with fentanyl versus patient-controlled analgesia with fentanyl during painless labor

Introduction
Adequate pain relief is essential for patient healthcare, as it decreases hormonal stress response and hazards of postoperative analgesic drug effect, provides early ambulation and better wound healing, and is highly economical.
Aim
The aim of this study as a primary outcome is to compare and evaluate the efficacy and duration of analgesia between walking epidural analgesia using low-dose levobupivacaine with fentanyl versus intravenous patient-controlled analgesia (IV-PCA) with fentanyl during labor, and also, maternal satisfaction by visual analogue pain scale, whereas the secondary outcomes are maternal hemodynamic stability, obstetric outcomes, postoperative complications, and neonatal outcomes in terms of APGAR score and arterial blood gases.
Patients and methods
Eighty full-term primigravida patients, with American Society of Anesthesiologist status I and II scheduled for elective spontaneous vaginal delivery and requested analgesia, were divided into two groups: group I (=40) was the epidural levobupivacaine with fentanyl (ELF) group, which received levobupivacaine 0.0625% with fentanyl 1 mcg/ml, 15 ml as initiation injection, followed by top-up doses of 5 ml in epidural catheter every 1 h or on patient's request, whereas group II (=40) was the IV-PCA group, which received 1 mcg/kg fentanyl intravenous as bolus dose, and then fentanyl 20 mcg increment (2 ml) with lockout interval of 5 min and at basal rate of 2 ml/h.
Results
On comparing ELF with IV-PCA groups, obstetric patient's satisfaction was significantly more in ELF group (<0.001), cervical dilatation was significantly rapid in ELF group (=0.028), and also the duration to vaginal delivery was significantly lower in ELF group (=0.037), whereas the results were insignificant for spontaneous vaginal delivery (=0.728), instrumental vaginal delivery (=0.526), and occasionally cesarean section (>0.05). Maternal visual analogue pain scale was significantly less in ELF group from the fourth hour (<0.001). Postoperative complications were insignificantly different between both the groups (>0.05).
Conclusion
Epidural analgesia using low-concentration levobupivacaine 0.0625% with fentanyl 1 mcg/ml during early labor provided better analgesia and resulted in short duration for vaginal delivery than systemic analgesia. Patient-controlled analgesia is a good technique for the patients during labor if they refuse epidural analgesia or patients have any other contraindication to epidural analgesia.