RESUMO
BACKGROUND: To evaluate the efficacy and safety of programmed intermittent epidural bolus (PIEB) in parturients. METHODS: The PubMed, Embase, and the Cochrane Library (from inception to July 2021) were searched for identification of randomized placebo-controlled trials in which PIEB was applied in parturients. The outcomes were the effect of analgesia, satisfaction score, mode of delivery, duration of labor, neonatal condition, and adverse events. The pooled odds ratios (OR), weighted mean difference (WMD), and 95% confidence intervals (CIs) were calculated using random- and fixed-effects models. RESULTS: PIEB was found to be associated with decreased total consumption of ropivacaine (WMDâ=â-15.83, 95% CI: -19.06 to -12.60, Pâ<â.00001; I2â=â61%; P for heterogeneityâ=â.04), total consumption of sufentanil (WMDâ=â-4.93, 95% CI: -6.87 to 2.98, Pâ<â.00001; I2â=â68%; P for heterogeneityâ=â.05), numbers of patients who require patient-controlled epidural analgesia bolus (ORâ=â0.27, 95% CI: 0.14-0.51, Pâ<â.0001; I2â=â65%; P for heterogeneityâ=â.01), the number of attempts (WMDâ=â-4.12, 95% CI: -7.21 to -1.04, Pâ=â.009; I2â=â100%; P for heterogeneityâ<â.00001), rate of breakthrough pain (ORâ=â0.47, 95% CI: 0.28-0.80, Pâ=â.005; I2â=â47%; P for heterogeneityâ=â.09). Eight studies focus on the duration of analgesia. After by meta-analysis, we found that the pain visual analogue scale (VAS) score at 30 minutes, 2âhours, 4âhours, and 5âhours in PIEB group was significantly lower when compared with control group, (WMDâ=â-0.15, 95% CI: -0.26 to -0.04, Pâ=â.006; I2â=â0%; P for heterogeneityâ=â.64), (WMDâ=â-0.79, 95% CI: -1.32 to 0.25, Pâ=â.004; I2â=â97%; P for heterogeneityâ<â.00001), (WMDâ=â-1.00, 95% CI: -1.08 to -0.91, Pâ<â.00001; I2â=â0%; P for heterogeneityâ=â.67), (WMDâ=â-1.81, 95% CI: -3.23 to -0.39, Pâ=â.01; I2â=â98%; P for heterogeneity < .00001), respectively. Nineteen studies discussed the mode of delivery between 2 groups. The results suggest that the rate of normal delivery is significantly higher in PIEB group compared with control group (ORâ=â1.37, 95% CI: 1.08-1.75, Pâ=â.01). The time of first and second stage of labor are significantly shorter in PIEB group compared with control group, the result is (WMDâ=â-10.52, 95% CI: -14.74 to 4.76, Pâ<â.00001; I2â=â0%; P for heterogeneityâ=â.86), (WMDâ=â-1.48, 95% CI: -2.26 to -0.69, Pâ=â.0002; I2â=â35%; P for heterogeneityâ=â.10), respectively. Thirteen studies concerned the satisfaction score of patients. The satisfaction score of patients in the PIEB group was significantly higher when compared with control group (WMDâ=â0.91, 95% CI: 0.42-1.39, Pâ=â.0003; I2â=â98%; P for heterogeneity < .00001). The Apgar score at 1, 5âminutes in PIEB group are significantly higher (WMDâ=â0.07, 95% CI: 0.02-0.13 Pâ=â.007; I2â=â55%; P for heterogeneityâ=â.04), (WMDâ=â-0.08, 95% CI: -0.12 to -0.05, Pâ<â.00001; I2â=â21%; P for heterogeneityâ=â.27), respectively. CONCLUSIONS: PIEB is a good alternative for labor analgesia with better analgesic effect, maternal and infant outcome.