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Excerpt
In a recently published article, Ferrante et al. [1] suggested that "there are little or no data" comparing the analgesic efficacy of patient-controlled epidural analgesia (PCEA) when administered with or without a background (basal) infusion. In the obstetric setting, two previously published studies have demonstrated that a background infusion is not necessary to provide satisfactory pain relief during labor [2,3]. These studies also indicated that "bolus-only" PCEA was associated with a reduction in total drug consumption and was not associated with an increased need for physician-administered "top-up" doses. It was gratifying to learn that the results of the study by Ferrante et al. [1] also confirmed our findings regarding the influence of a basal infusion on pain control with PCEA after cesarean delivery [4]. Analogous to the findings with intravenous background infusions [5,8], use of a basal infusion with PCEA failed to significantly improve its analgesic effectiveness [1,4].
While the side effects resulting from the addition of a background infusion with PCEA are minimal, serious complications are rare events and are therefore unlikely to be seen in clinical studies involving small group sizes (n = 15). Given the inherent risks [7] and limited benefits to the patient associated with the routine use of continuous background infusions, we strongly disagree with the authors' conclusions regarding the advisability of using a background infusion during PCEA therapy. In contrast, we would encourage practitioners to use the "bolus-only" technique with PCEA.
Paul F. White, PhD, MD, FANZCA
David R. Gambling, MB, FRCPC
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX 75235-8894
Robert K.
