Intermittent epidural bolus versus continuous epidural infusions for labor analgesia: A meta-analysis of randomized controlled trials

Xian Liu,Haijing Zhang,Mengzhuo Guo,Yuanchao Gao,Chunyan Du,Huan Zhang,Ehab Farag

doi:10.1371/journal.pone.0234353

Xian Liu, Haijing Zhang + Show 5 more

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https://doi.org/10.1371/journal.pone.0234353

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Abstract

There are inconsistent results regarding the efficacy and safety of intermittent epidural bolus (IPB) versus continuous epidural infusions (CPI) for labor analgesia. This study used a meta-analytic approach to assess the safety and treatment efficacy of IPB versus CPI for labor analgesia based on randomized controlled trials (RCTs). Four electronic databases were used to identify eligible RCTs. Pooled effect estimates at 95% confidence intervals (CIs) were calculated using a random-effects model. Twenty-two RCTs with 2,573 parturients were selected for final analysis. The findings revealed no significant differences between IPB and CPI for the incidences of cesarean and instrumental delivery. IPB was shown to be associated with shorter total duration of labor [weighted mean difference (WMD): −21.46; 95% CI: −25.07 to −17.85; P < 0.001], duration of the first of stage of labor (WMD: −13.41; 95% CI: −21.01 to −5.81; P = 0.001), and duration of the second stage of labor (WMD: −4.98; 95% CI: −9.32 to −0.63; P = 0.025). Furthermore, IPB significantly reduced the incidences of required anesthetic interventions compared with CPI [relative risk (RR): 0.61; 95% CI: 0.39–0.95; P = 0.030], whereas there was no significant difference between IPB and CPI for the time required in the first anesthetic intervention (WMD: 7.73; 95% CI: −33.68–49.15; P = 0.714). The local anesthetic IPB (bupivacaine equivalents) was associated with lower milligrams per hour of local anesthetic (WMD: −0.89; 95% CI: −1.41 to −0.36; P = 0.001) and better maternal satisfaction (WMD: 8.76; 95% CI: 4.18–13.35; P < 0.001). There were no significant differences between IPB and CPI for the risk of adverse events. This study found that parturients with IPB have short total duration of labor and duration of the first and second stage of labor, reduced requirements for additional anesthetic interventions, and improved maternal satisfaction.

Highlights

Childbirth is arguably one of the most painful experiences for parturients [1]
Patient-controlled epidural analgesia (PCEA) was associated with better maternal satisfaction and lower risk of adverse events, whereas the use of patient-controlled epidural analgesia (PCEA) monotherapy did not yield a significant effect on pain control in parturients and clinician’s workload [5, 6]
There was no significant difference between intermittent epidural bolus (IPB) and continuous epidural infusions (CPI) on the time required for first anesthetic intervention [weighted mean difference (WMD): 7.73; 95% confidence intervals (CIs): −33.68 to 49.15; P = 0.714; significant heterogeneity (I2 = 83.4%; P < 0.001); Fig 8)]

Summary

Introduction

The degree of pain experienced and relief could affect maternal satisfaction during the birthing process, resulting in long-term emotional and psychological effects [2]. IPB versus CPI for labor analgesia need for an effective analgesic strategy for the improvement of maternal satisfaction with minimal adverse events [3]. Another study has demonstrated that the analgesic effects of labor neuraxial analgesia were superior to those of parenteral opioids, nitrous oxide, and other nonpharmacologic strategies, with limited effects on the mode of delivery and outcomes in mothers and neonates [4]. Patient-controlled epidural analgesia (PCEA) was associated with better maternal satisfaction and lower risk of adverse events, whereas the use of PCEA monotherapy did not yield a significant effect on pain control in parturients and clinician’s workload [5, 6]

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