Korean J Anesthesiol.  2019 Oct;72(5):472-478. 10.4097/kja.19156.

Programmed intermittent epidural bolus as compared to continuous epidural infusion for the maintenance of labor analgesia: a prospective randomized single-blinded controlled trial

• Fidkowski
• Shah S
• Alsaden MR

• KMID: 2465746
• DOI: http://doi.org/10.4097/kja.19156

Abstract

BACKGROUND
Programmed intermittent epidural bolus (PIEB) techniques are a new area of interest for maintaining labor analgesia due to the potential to decrease motor block and improve labor analgesia. This study compares continuous epidural infusion (CEI) to 2 PIEB regimens for labor analgesia.
METHODS
One hundred fifty patients undergoing scheduled induction of labor at term gestation having epidural labor analgesia were randomized to receive an epidural analgesia regimen of bupivacaine 0.125% with fentanyl 2 μg/ml at either PIEB 5 ml every 30 min (Group 5q30), PIEB 10 ml every 60 min (Group 10q60), or 10 ml/h continuous infusion (Group continuous epidural infusion [CEI]). The primary outcome is the pain scores throughout labor. Secondary outcomes include degree of motor block, dermatomal sensory levels, the number of physician-administered boluses, and patient satisfaction.
RESULTS
While the average pain scores throughout labor did not differ significantly between groups, fewer patients in group 10q60 received physician-administered boluses for breakthrough pain (34.9% in 10q60 vs. 61.0% in 5q30 and 61.9% in CEI, P = 0.022). Dermatomal sensory levels, degree of motor block, and patient satisfaction did not differ significantly between groups.
CONCLUSIONS
Our study suggests that high volume PIEB regimens for labor analgesia decrease breakthrough pain and physician-administered boluses.

Keyword

Bupivacaine; Continuous epidural infusion; Epidural analgesia; Fentanyl; Induction of labor; Labor analgesia; Programmed intermittent epidural bolus

MeSH Terms

Analgesia*
Analgesia, Epidural
Breakthrough Pain
Bupivacaine
Fentanyl
Humans
Patient Satisfaction
Pregnancy
Prospective Studies*
Bupivacaine
Fentanyl