///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

EFFECT OF MANIPULATION OF THE PROGRAMMED INTERMITTENT BOLUS TIME INTERVAL AND INJECTION VOLUME ON TOTAL DRUG USE AND QUALITY OF LABOR EPIDURAL ANALGESIA

Abstract Number: 63
Abstract Type: Original Research

Cynthia A Wong M.D.1 ; Bradley Hewlett M.D.2; Laurie A Chalifoux M.D.3

Introduction: Programmed intermittent bolus (PIEB) is a technique for administration of epidural solution in which the epidural pump is programmed to administered a maintenance bolus dose at regular intervals. PEIB compared with continuous infusion of epidural solution results in decreased anesthetic consumption, increased patient satisfaction, and a decreased need for anesthesia provider intervention to maintain satisfactory labor analgesia.1 The purpose of this study was to evaluate the manipulation of the programmed intermittent bolus time interval and volume during the maintenance of epidural labor analgesia.

Methods: The study was approved by the IRB and written informed consent was obtained. Combined spinal-epidural analgesia with intrathecal bupivacaine 1.25 mg and fentanyl 15 g was initiated in healthy, term, nulliparous parturients. A single-orifice epidural catheter was secured 4-5 cm in the epidural space and a test dose of lidocaine 45 mg with epinephrine 15 g was administered. If the VAS <10 mm at 10 min, the subject was randomized to one of 3 PIEB analgesia maintenance regimens: 2.5 mL q 15 min (2.5/15), 5 mL every 30 min (5/30), and 10 mL every 60 min (10/60). The maintenance epidural solution consisted of bupivacaine 0.0625% with fentanyl 1.95 g/mL. Breakthrough pain was treated with PCEA and manual bolus doses by the anesthesiologist. VAS for pain was determined q 120 min until delivery. The primary outcome variable was total bupivacaine consumption per hour of labor analgesia.

Results: 190 women were studied. Patients randomized to Group 10/60 consumed less bupivacaine but a similar amount of fentanyl per hour of labor compared to women in Groups 2.5/15 and 5/30 (Figure)( P<0.05). The area under the VAS pain scores versus time normalized for duration of labor and the VAS at delivery in subjects with vaginal delivery was not different among groups. There were no differences among groups in PCEA requests or administrations, number of manual rebolus doses, time to first PCEA dose or manual bolus dose, or patient satisfaction with labor analgesia.

Discussion: The important finding of this study was that extending the PIEB interval and volume from 15 min to 60 min decreased bupivacaine consumption and variability without decreasing patient comfort of satisfaction. Further studies evaluating PIEB regimens in laboring parturients are warranted.

References: Anesth Analg 2006;102:904-9.



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