A prospective, randomized, blinded-endpoint, controlled study - continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia

Braz J Anesthesiol. Sep-Oct 2016;66(5):439-44. doi: 10.1016/j.bjane.2014.12.006. Epub 2015 Nov 19.

Abstract

Background: There is evidence that administration of a programmed intermittent epidural bolus (PIEB) compared to continuous epidural infusion (CEI) leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions.

Methods: In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10mL with Ropivacaine 0.16% plus Sufentanil 10μg, parturient were randomly assigned to one of three regimens: A - Ropivacaine 0.15% plus Sufentanil 0.2μg/mL solution as continuous epidural infusion (5mL/h, beginning immediately after the initial bolus); B - Ropivacaine 0.1% plus Sufentanil 0.2μg/mL as programmed intermittent epidural bolus and C - Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10mL/h starting 60min after the initial bolus. Rescue boluses of 5mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes.

Results: We analyzed 130 pregnants (A=60; B=33; C=37). The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p=0.83). We found a higher caesarean delivery rate in group A (56.7%; p=0.02). No differences in motor block, instrumental delivery rate and neonatal outcomes were observed.

Conclusions: Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes.

Keywords: Analgesia; Analgesia obstétrica; Bolus intermitente programado; Epidural; Epidural analgesic techniques; Infusion; Infusão; Obstetric analgesia; Programmed intermittent bolus; Técnicas de analgesia epidural.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Analgesia, Epidural / methods*
  • Analgesia, Obstetrical / methods*
  • Analgesia, Patient-Controlled
  • Anesthetics, Local / administration & dosage
  • Cesarean Section / statistics & numerical data
  • Double-Blind Method
  • Endpoint Determination
  • Female
  • Humans
  • Infant, Newborn
  • Infusion Pumps
  • Patient Satisfaction
  • Pregnancy
  • Prospective Studies

Substances

  • Anesthetics, Local