Patient-controlled analgesia (PCA) using fentanyl in a parturient with a platelet function abnormality.

A term parturient with documented platelet dysfunction presented to the case room for induction of labour. Since this bleeding abnormality contraindicated the use of lumbar epidural analgesia (LEA), we elected to use an iv fentanyl patient-controlled analgesia (PCA) technique for pain relief during labour. The patient received a 50 micrograms fentanyl loading dose after which 20 micrograms boluses of fentanyl were self-administered every three minutes as required. The patient received a total of 400 micrograms of fentanyl over the 3 1/2 hr of active labour. Mother and neonate tolerated the fentanyl without sequelae. If facilities to monitor the neonate and mother are present, this method of analgesia is useful in those patients where LEA is contraindicated.