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

Abstract

BackgroundThere 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. MethodsIn 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. ResultsWe 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. ConclusionsMaintenance 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.