Programmed intermittent epidural bolus decreases the incidence of intra-partum fever for labor analgesia in primiparous women: a randomized controlled study.

Abstract

To evaluate whether programmed intermittent epidural bolus (PIEB) reduces the incidence of maternal intra-partum fever compared with continuous epidural infusion (CEI) during labor. Parturients were randomized to receive CEI (CEI group) or PIEB (PIEB group) with 10ml per hour for epidural labor analgesia with 1500 subjects in each group. The maintaining dose of two groups is 0.08% ropivacaine with 0.4μg/ml sufentanil, with patient-controlled epidural analgesia (PCEA) dose of 5ml and lockout interval of 30min. The incidence of maternal fever, pain score, epidural sensory levels, the number and proportion of PCEA demand, anesthetics consumption, satisfaction score, neonatal Apgar scale, and maternal and neonatal side effects were recorded. It was significantly lower of the incidence of maternal fever beginning at 4h post-analgesia and continuing until delivery in the PIEB group than the CEI group (4h: 2.6% vs. 4.2%; 5h: 7.3% vs. 10.2%; delivery: 5.6% vs. 7.9%; 1h post-delivery: 3.9% vs. 6.2%; 2h post-delivery: 2.1 vs. 3.5%; total: 5.8% vs. 8.4% in PIEB and CEI, respectively). Compared with CEI group, pain scores at 3, 4, 5h post-analgesia and delivery (3h: 2 [1, 2] vs. 2 [1-3]; 4h: 2 [2, 3] vs. 3 [2-4]; 5h: 2 [2, 3] vs. 3 [2-4]; delivery: 3 [2-4] vs. 4 [3, 4] in PIEB and CEI, respectively), the number and proportion of PCEA demand (number: 0.7 ± 0.9 vs. 2.2 ± 1.9; proportion: 42.0% vs. 80.3% in PIEB and CEI, respectively), and anesthetics consumption significantly decreased in the PIEB group (Ropivacaine: 60 ± 13mg vs. 76 ± 17mg; Sufentanil: 26 ± 4mg vs. 32 ± 6mg in PIEB and CEI, respectively), without severe maternal and neonatal side effects and any difference in neonatal Apgar scale. The epidural sensory levels 2h post-analgesia (2h: 8[8, 9] vs. 9[8, 9] in PIEB and CEI) and satisfaction score (9 [9, 10] vs. 7 [6, 7] in PIEB and CEI) were significantly higher in the PIEB group compared with those in the CEI group. PIEB with 10ml of 0.08% ropivacaine and 0.4μg/ml sufentanil hourly provided a lower incidence of intra-partum fever with a better analgesic effect compared with CEI, without any severe maternal and neonatal adverse reactions.