Programmed intermittent epidural bolus as an ideal method for labor analgesia: a randomized controlled trial.
Korean J Anesthesiol
; 77(1): 106-114, 2024 Feb.
Article
em En
| MEDLINE
| ID: mdl-37312414
ABSTRACT
BACKGROUND:
Although programmed intermittent epidural bolus (PIEB) is effective for labor analgesia, an appropriate flow rate has not been established. Therefore, we investigated the analgesic effect based on different epidural injection flow rates.METHODS:
Nulliparous women scheduled for spontaneous labor were enrolled in this randomized trial. After injection of intrathecal 0.2% ropivacaine 3 mg with fentanyl 20 µg, participants were randomized to three study groups. Epidural analgesics, 10 ml during one hour, were administered with patient controlled epidural analgesia as follows (0.2% ropivacaine 60 ml, fentanyl 180 µg, and 0.9% saline 40 ml) continuous (n = 28, 10 ml/h for continuous infusion), PIEB (n = 29, 240 ml/h for bolus infusion of 10 ml), or manual (n = 28, 1200 ml/h for bolus injection of 10 ml). The primary outcome was hourly consumption of the epidural solution. The time interval between labor analgesia and the first breakthrough pain was investigated.RESULTS:
The median (Q1, Q3) hourly consumption of epidural anesthetics was significantly different among the groups (continuous 14.3 [8.7, 16.9] ml, PIEB 9.4 [6.2, 9.8] ml, manual 8.6 [7.6, 9.9] ml; P < 0.001). The time to breakthrough pain for the PIEB group was longer than that for the other groups (continuous 78.5 [35.8, 185.0] min, PIEB 200.0 [88.5, 441.5] min, manual 60.5 [37.3, 162.0] min, P = 0.027).CONCLUSIONS:
PIEB, with a low-flow rate, provided more adequate labor analgesia than a continuous epidural infusion or manual injection with a high-flow rate.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Analgesia Epidural
/
Dor Irruptiva
Tipo de estudo:
Clinical_trials
Limite:
Female
/
Humans
Idioma:
En
Revista:
Korean J Anesthesiol
Ano de publicação:
2024
Tipo de documento:
Article