Effect of patient-controlled epidural analgesia with and without automatic intermittent bolus on levobupivacaine consumption during labour: A single-centre prospective double-blinded randomised controlled study.
Anaesth Crit Care Pain Med
; 40(5): 100936, 2021 10.
Article
en En
| MEDLINE
| ID: mdl-34391982
ABSTRACT
BACKGROUND:
During labour, the effects of adding a programmed intermittent epidural bolus (PIEB) baseline analgesic regimen to patient-controlled epidural analgesia (PCEA) remain uncertain.METHODS:
This single centre prospective double-blinded controlled study randomised nulliparous women over 35 weeks of gestational age in a PCEAâ¯+â¯PIEB or PCEA only group. After an epidural analgesia catheter was inserted, a specific pump administered a solution of levobupivacaine 0.625â¯mgâ¯mL-1, sufentanil 0.25⯵gâ¯mL-1, and clonidine 0.375⯵gâ¯mL-1. In both groups the PCEA mode delivered an 8â¯mL bolus with a lockout period of 8â¯min. In the PCEAâ¯+â¯PIEB group, women also received a programmed 8â¯mL bolus every 60â¯min. Additional bolus were allowed if required. The primary outcome was the hourly consumption of levobupivacaine from epidural catheter placement to new-born delivery. Secondary outcome were motor block, oxytocin use, sufentanil consumption, additional bolus required, instrumental vaginal delivery, unplanned caesarean section, pain during labour and women's satisfaction.RESULTS:
Analysis included 162 and 155 women in the PCEA and PCEAâ¯+â¯PIEB groups, respectively. The median [IQR] hourly consumption of levobupivacaine was significantly lower in the PCEA group (9.9 (7.8-12.4]â¯mgâ¯h-1) as compared to the PCEAâ¯+â¯PIEB group (11.2 [7.9-14.3]â¯mgâ¯h-1; pâ¯=â¯0.046). The difference between medians was 1.3â¯mgâ¯h-1 95 % CI (0.1-2.9). There was no difference between groups for secondary outcomes.CONCLUSIONS:
PCEA only modestly decreased the hourly consumption of local anaesthetic as compared to PCEAâ¯+â¯PIEB but the difference was not clinically relevant.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Analgesia Epidural
/
Analgesia Obstétrica
Tipo de estudio:
Clinical_trials
/
Observational_studies
Límite:
Female
/
Humans
/
Pregnancy
Idioma:
En
Revista:
Anaesth Crit Care Pain Med
Año:
2021
Tipo del documento:
Article
País de afiliación:
Francia