The incidence of breakthrough pain associated with programmed intermittent bolus volumes for labor epidural analgesia: a randomized controlled trial.
Int J Obstet Anesth
; 51: 103571, 2022 08.
Article
en En
| MEDLINE
| ID: mdl-35863947
ABSTRACT
BACKGROUND:
In this randomized, blinded study, we evaluated the effects of different programmed intermittent epidural bolus (PIEB) volumes for labor analgesia on the incidence of breakthrough pain and other analgesic outcomes.METHODS:
Nulliparous women with term cephalic singleton pregnancies who requested labor analgesia had epidural analgesia initiated with 10â¯mL 0.1% ropivacaine with sufentanil 0.3⯵g/mL. The pump was programmed to deliver a 4, 6 or 8â¯mL bolus every 45â¯min (groups 4, 6 or 8, respectively). The primary outcome was the incidence of breakthrough pain, defined as inadequate analgesia after two patient-controlled epidural analgesia administrations in a 20-min period. Secondary outcomes included ropivacaine consumption, time of the first patient-controlled epidural analgesia request, duration of the second stage of labor, and incidence of motor block.RESULTS:
Among 210 women randomly allocated the incidence of breakthrough pain was 34.9%, 19.7%, and 13.1%, for groups 4, 6 and 8, respectively (P=0.011). The incidence of breakthrough pain in group 8 was lower than in group 4 (P=0.006). The median (interquartile range) hourly ropivacaine consumption was 8.2â¯mg/h (7.1-11.3), 10.4â¯mg/h (9.2-13.0), and 12.0â¯mg/h (11.2-13.8) in groups 4, 6 and 8, respectively (Pâ¯<0.001). Group 8 had a longer duration of effective analgesia and longer second stage of labor than group 4. There was no significant difference between groups in the incidence of motor block.CONCLUSION:
The larger PIEB volumes were preferred for epidural labor analgesia compared with a smaller volume because of improved analgesia without clinically significant increases in adverse effects.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Analgesia Epidural
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Analgesia Obstétrica
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Dolor de Parto
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Dolor Irruptivo
Tipo de estudio:
Clinical_trials
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Incidence_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Female
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Humans
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Pregnancy
Idioma:
En
Año:
2022
Tipo del documento:
Article