Programmed intermittent epidural bolus for post-cesarean delivery analgesia: a randomized controlled double-blind trial.

Abstract

The aim of this study was to assess the efficacy of programmed intermittent epidural boluses (PIEB) in postoperative pain management compared with continuous epidural infusion (CEI) after cesarean delivery. A total of 58 participants were randomly allocated to receive PIEB (3mL bolus every 60min) or CEI (3mL/h) for postoperative analgesia after undergoing elective cesarean section under combined spinal-epidural anesthesia. Both groups had the same epidural solution containing ropivacaine 0.2% plus fentanyl 2µg/mL. The primary outcome was postoperative pain score at rest and mobilization at 6, 12, 24, and 48h. The secondary outcomes were the total amount of ropivacaine used in the 48h study period and the time to the first PCEA bolus. Data from 58 women were analyzed. There was a reduction in pain verbal numerical rating scores at 12h in patients receiving PIEB compared with CEI at rest [2 (1.75-3) vs. 3 (2-4), p = 0.011]; and on movement [4 (3-5) vs. 5 (4-6), p = 0.038]. No differences were found in pain scores at any other time-point up to 48h. Total ropivacaine consumption at 48h was less in the PIEB group compared with the CEI group [316mg (304-321) vs. 336mg (319-344), p = 0.001]. Postoperative epidural analgesia for patients who underwent cesarean delivery with PIEB compared with CEI resulted in less ropivacaine usage while providing comparable analgesia.