Patient Controlled Epidural Analgesia Versus Continuous Epidural Infusion: Obstetrical and Neonatal Outcomes

The investigators intend to perform a large randomized trial using standardized obstetrical and anesthetic practice at a single institution to determine the effects of patient controlled epidural analgesia on obstetrical and neonatal outcomes.

Women in their first pregnancy in spontaneous labor desiring epidural anesthesia will be randomized to one of three groups. Each group will initially be given intrathecal bolus. Before and 30 minutes after the initial bolus, the patient's verbal pain score will be recorded. The continuous epidural infusion group (Group I) will be started immediately on a continuous pump infusion.They will also have the opportunity to give a PCA bolus Finally, the patient controlled epidural group (Group III) will be able to give a bolus every 20 minutes with no continuous infusion. Each group will also be allowed 2 boluses,by the anesthesia staff in the event that their pain is not controlled by the indicated study medication. An hourly evaluation of verbal pain score and maternal mobility will be recorded. After delivery, obstetrical outcomes, neonatal outcomes, anesthesia interventions, and patient satisfaction questionnaires will then be collected.

• Drug: bupivicaine epidural
  bupivicaine continuous epidural infusion
  Other Name: Marcaine
• Drug: bupivicaine epidural infusion patient epidural
  bupivicaine
  Other Name: marcaine
• Drug: bupivicaine
  patient controlled anesthesia only
  Other Name: marcaine

• Experimental: 1
  Continuous epidural infusion of medication for method of pain relief
  Intervention: Drug: bupivicaine epidural
• Experimental: 2
  continuous epidural infusion in conjuction with patient controlled anesthesia (PCA)
  Intervention: Drug: bupivicaine epidural infusion patient epidural
• Experimental: 3
  patient controlled anesthesia only this arm has pt controlled medication delivery. (PCA)
  Intervention: Drug: bupivicaine

Inclusion Criteria:

• Early labor
• Nulliparous

Exclusion Criteria:

• Inductions
• Breech
• Contraindications to regional anesthesia