Patient controlled epidural anaesthesia (PCEA)
Patient controlled epidural anaesthesia (or PCEA) is when the woman self-administers doses of the epidural medications to control her pain relief during the labour. It works on similar principles to
patient controlled analgesia (or PCA), which is often used for intravenous (IV) pain relief after a Caesarean birth. PCEA is used in some hospitals but at present is not widely offered. Check with your caregiver or Delivery Suite.
PCEA entails the anaesthetist inserting the epidural catheter and giving the first dose of medications (usually a narcotic / local mix of medications), to make the woman comfortable. They will then fill a large syringe with the epidural medications and attached it to a push button, hand held device. The woman is shown how to use the device. When the pain of the contractions starts to return (after 1 to 2 hours), the woman can press the button to administer a small dose of medications through the epidural. There is usually a lag period of about 5 to 10 minutes before the new dose of medications take full effect.
The device has a set 'lock-out' time that prevents the woman from giving herself too much medication if the button is pressed multiple times, over a short period. If the pain relief is not adequate, then the anaesthetist will need to give more medications or increase the amount the woman can self-administer. This may happen as the labour progresses and the nature of the pain changes. It is important that only the woman uses the device (not the partner or support person), as she is the one feeling the pain.
PCEA was developed to: