Parturient-controlled Epidural Analgesia Research Articles

Programmed intermittent epidural boluses (pieb) for labor analgesia: study of the sensor block and effects on maternal motor function

Background. Programmed intermittent epidural boluses (PIEB) technique is a promising approach that demonstrates certain advantages over traditional techniques of epidural analgesia. We compared the dynamics of the sensory block of PIEB + parturient-controlled epidural analgesia (PCEA) with continuous epidural infusion (CEI) + PCEA for maintenance labor analgesia and the incidence of motor block (MB) in women who received PIEB or traditional techniques.
 Methods. A total of 165 subjects were studied. All parturients were divided into five groups: manual boluses, PCEA, PCEA + CEI, PIEB + PCEA; levobupivacaine 0.25 mg/mL; 1.25 mg/mL; 0.625 mg/mL. The level of the MB was evaluated by the classic Bromage scale (0-1-2-3). The level of the sensor block was evaluated by the pin-prick test.
 Results. MB was reported in 80% in group 1 120 min after analgesia, 78% and 52% in groups 2 and 3 at the 150th min (p 0.001); in group 4, the MB frequency was 6% 15 min after the start and was increasing to 40% at full cervical dilation (p 0.001). In group 5, the relative MB frequency did not exceed 10% at the 120th min and was 0% at full cervical dilation (p 0.00001). The results indicate that in the PIEB group, the level of sensory block in patients was higher 15 min after the start of analgesia and remained so until the end of the observation period [median PIEB Th5 versus Th8 in the CEI group, (p 0.0004)].
 Conclusions. PIEB + PCEA technique maintained a consistently high level of sensor block throughout the study compared to PCEA + CEI, which ensured effective analgesia in the first and second stages of labor with minimal MB.

Parturient Controlled Epidural Analgesia with and without Basal Infusion of Ropivacaine and Fentanyl: A Randomized Trial.

Introduction:Parturient controlled epidural analgesia (PCEA) is an established method of providing safe and effective labor analgesia.Objective:The aim of this single-blind, randomized controlled trial was to compare the efficacy of PCEA with or without basal infusion (BI) of ropivacaine and fentanyl for the effective management of labor pain associated with normal vaginal delivery.Materials and Methods:A total of 78 nulliparous parturients with vertex presentation at term and with cervical dilatation of 3–5 cm demanding for epidural analgesia (EA) were enrolled in the study. EA was initiated and maintained with ropivacaine 0.125% and fentanyl 2 μg/mL. Following an initial epidural loading volume of 8–10 mL, parturients were randomly allocated in two groups of 39 each. PCEA group received bolus of 5 mL at 200 mL/h with lockout interval of 15 min and with maximum volume of local anaesthetic was 20 mL/h and PCEA + BI group – receiving added BI rate of 5 mL/h along with same programmed parameters of PCEA pump.Results:No statistically significant difference was observed between the groups in terms of demographic characteristics, duration of labor, delivery methods, maternal satisfaction as well as Apgar score. Mean demand bolus in group PCEA + BI was 0.39 ± 0.59, whereas in group PCEA was 3.31 ± 0.77 (P < 0.05). Mean volume of drug used in group PCEA + BI was 25.57 ± 2.75 mL, while in group PCEA was 22.42 ± 4.56 mL (P = 0.0005). In PCEA + BI group, Visual Analog Scale (VAS) score was 0.07 ± 0.35 at 60 min and 0.06 ± 0.33 at 120 min, whereas in PCEA group, VAS was 0.32 ± 0.62 at 60 min and 0.26 ± 0.50 at 120 min (P = 0.05), respectively.Conclusion:BI when added to PCEA, it significantly reduces breakthrough labor pain and demand boluses without prolonging labor duration but at the cost of increased requirement of drug volume when compared to PCEA only group.

A Systematic Review and Meta-Analysis Comparing Programmed Intermittent Bolus and Continuous Infusion as the Background Infusion for Parturient-Controlled Epidural Analgesia

The programmed intermittent epidural bolus (PIEB) technique offers multiple benefits over continuous epidural infusion (CEI), but controversy still exists when it is used in conjunction with a parturient-controlled epidural analgesia (PCEA) regimen. A systematic review and meta-analysis was thus conducted using the Medline, EMBASE, CENTRAL and Web of Science databases with the aim of identifying those randomized controlled trials (RCTs) that performed a comparison between PIEB and CEI in healthy parturients using a PCEA regimen with regard to the duration of labor, labor pain, anesthesia interventions, maternal satisfaction and main side effects. The data were analyzed using a random-effects model. Eleven eligible trials were included, in which 717 participants were allocated to the PIEB + PCEA group and 650 patients were allocated to the CEI + PCEA group. The rate of instrumental delivery, incidence of breakthrough pain, PCEA usage rates and local anesthetic usage were significantly reduced, the labor duration was statistically shorter, and the maternal satisfaction score was significantly improved in the PIEB + PCEA group compared with that in the CEI + PCEA group. There were no differences in the side effects between the two groups. The results of the present study suggest that the PIEB technique in conjunction with the PCEA regimen was more advantageous than CEI + PCEA, but additional studies should be conducted to consistently demonstrate an improvement in the maternal and fetal obstetric outcomes.

A Comparison of a Basal Infusion With Automated Mandatory Boluses in Parturient-Controlled Epidural Analgesia During Labor

A Comparison of a Basal Infusion With Automated Mandatory Boluses in Parturient-Controlled Epidural Analgesia During Labor

A Comparison of a Basal Infusion with Automated Mandatory Boluses in Parturient-Controlled Epidural Analgesia During Labor

A Comparison of a Basal Infusion with Automated Mandatory Boluses in Parturient-Controlled Epidural Analgesia During Labor

A Comparison of a Basal Infusion with Automated Mandatory Boluses in Parturient-Controlled Epidural Analgesia during Labor

A Comparison of a Basal Infusion with Automated Mandatory Boluses in Parturient-Controlled Epidural Analgesia during Labor

A Comparison of a Basal Infusion with Automated Mandatory Boluses in Parturient-Controlled Epidural Analgesia During Labor

The use of parturient-controlled epidural analgesia (PCEA) with a basal infusion is commonly used in laboring women. We compared a novel approach of providing basal intermittent boluses concurrently with PCEA: PCEA plus automated mandatory boluses (PCEA+AMB) versus PCEA plus basal continuous infusion (PCEA+BCI). We hypothesized that epidural local anesthetic consumption would be lower if basal intermittent boluses were used instead of a basal infusion. We randomized 42 healthy parturients in early labor to receive 0.1% ropivacaine + fentanyl 2 microg/mL either via PCEA+BCI (n = 21,bolus 5 mL, lockout 10 min, basal infusion 5 mL/h) or via PCEA+AMB (n = 21, patient-activated bolus of 5 mL, lockout 10 min, basal automated boluses of 5 mL/h [omitted if a patient-activated bolus was successfully administered in the last 1 h]) after successful induction of combined spinal epidural analgesia. We found a reduction in the hourly consumption of ropivacaine with PCEA+AMB, i.e., the primary outcome measure (mean = 6.5 mL, sd = 3.4 in the PCEA+AMB group vs 7.5 mL, sd = 2.0 PCEA+BCI group, P = 0.011). A larger proportion of parturients in the PCEA+AMB group did not self-bolus (6/21 vs 1/21 in PCEA+BCI, P = 0.03). The time to the first self-bolus after combined spinal epidural was longer in the PCEA+AMB group (mean survival time 315 min vs 190 min in PCEA+BCI group, P = 0.04 by log rank test). There was no difference in pain scores or side effects. Our study showed that PCEA+AMB reduced analgesic consumption and could be useful as the mode of maintenance for epidural analgesia.

Comparison of patient controlled epidural analgesia with automated synchronized intermittent mandatory boluses for labor analgesia

INTRODUCTION: The use of continual intermittent boluses (CIB) to maintain labor epidural analgesia has been shown to prolong the duration of analgesia and reduce the incidence of breakthrough pain when compared with a continuous epidural infusion. (1, 2) The use of parturient controlled epidural analgesia (PCEA) with a basal infusion has been shown to reduce pain scores when compared with PCEA without basal infusion in the laboring women. (3) We compared a novel approach of providing basal intermittent boluses in synchrony with PCEA (called Automated Synchronized Intermittent Mandatory Boluses or ASIMB) with PCEA + basal infusion. METHODS: After hospital ethics committee approval and informed consent, we randomized 42 healthy parturients in early labor to receive 0.1% ropivacaine + fentanyl 2 microg/ml either via PCEA (n=21, bolus 5 ml, lockout 10 min, basal infusion 5 ml/H) or ASIMB (n=21, patient activated bolus of 5 ml, lockout 10 min, basal automated boluses of 5 ml) after successful induction of combined spinal epidural analgesia (CSEA) with intrathecal ropivacaine 2 mg + fentanyl 15 microg. We hypothesized that ASIMB would be a more efficient technique. The sample size was computed to detect a 20% reduction in local anesthetic consumption compared with PCEA (a;: 0.05, â;: 0.2). RESULTS: Even though there was no significant difference in the anthropometric and preanalgesic data between the two groups, there was reduction in the hourly consumption of ropivacaine with ASIMB (median: 5.7 mg/H, range 3.6-20 vs. median: 7.1, 5-12 for PCEA, p=0.01) A higher proportion of parturients in ASIMB did not self bolus (6/21 vs. 1/21 in PCEA, p=0.03). The time to the first self bolus after CSE was also longer in ASIMB (mean survival time 315 min vs. 190 min in PCEA group, p=0.04 by log rank test). There was no difference in pain scores or side effects. DISCUSSION: ASIMB is a good alternative to PCEA+basal infusion in maintaining labor epidural analgesia

Comparison of continuous background infusion plus demand dose and demand-only parturient-controlled epidural analgesia (PCEA) using ropivacaine combined with sufentanil for labor and delivery

Using ropivacaine combined with sufentanil, we determined the analgesic efficacy of parturient-controlled epidural analgesia (PCEA) with or without (demand-only PCEA) continuous background infusion in reducing labor pain in 66 parturients. After placement of the epidural catheter and administration of an initial bolus containing ropivacaine 16 mg and sufentanil 10 microg, parturients were prospectively randomized into two groups. The PCEA solution consisted of ropivacaine 0.16% plus sufentanil 0.5 microg/mL. Parturients with PCEA plus continuous background infusion received 4 mL/h plus an hourly maximum of three 4-mL boluses on demand (lock-out time 20 min); parturients with demand-only PCEA received an hourly maximum of four 4-mL boluses (lock-out time 15 min) of anesthetic solution. Pain scores (VAS 0-100 mm), drug doses administered, duration of labor, sensory and motor epidural block characteristics, maternal satisfaction, neonatal outcome and adverse events were determined. Both regimens provided excellent parturients' satisfaction and pain relief. However, periods of VAS scores>40 mm during all stages of labor were significantly more frequent in parturients receiving demand-only PCEA (22.4%) compared to parturients receiving PCEA plus continuous background infusion (7.5%, P=0.0011). Drug doses administered, duration of PCEA, labor and delivery, epidural block characteristics, neonatal outcome and adverse events did not differ between groups. Under the conditions of the study, PCEA plus continuous background infusion was more effective than demand-only PCEA in treating labor pain without increasing consumption of anesthetic solution.

▪ Motor Blockade Is Reduced with Ropivacaine 0.125% for Parturient-Controlled Epidural Analgesia during Labour

▪ Motor Blockade Is Reduced with Ropivacaine 0.125% for Parturient-Controlled Epidural Analgesia during Labour