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Continuous extradural analgesia: comparison of midwife top-ups, continuous infusions and patient controlled administration.

We have compared three techniques used to provide extradural analgesia during the first stage of labour: 0.25% plain bupivacaine 10 ml demand top-ups delivered by the midwife; continuous infusion of 0.125% plain bupivacaine 10 ml h-1; and patient-controlled extradural analgesia (PCEA) delivering 3-ml boluses of 0.25% bupivacaine. Each technique produced comparable analgesia achieving equivalent maternal satisfaction, with no difference in mode of delivery and no complications. This regimen for PCEA proved a viable alternative for continuous extradural analgesia and was popular with the mothers, midwives and anaesthetists.