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Automated intermittent epidural bolus (IEB) compared to continuous epidural infusions (CEI) for labor analgesia: A systematic review and meta-analysis.
Abstract Number: 21
Abstract Type: Meta Analysis/Review of the Li
INTRODUCTION: Small, regularly spaced intermittent boluses may lead to a more extensive spread of local anesthetic in the epidural space.(1) The objective of this systematic review is to assess the effects of IEB delivery of labor epidural analgesia compared to CEI.
METHODS: The Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), EMBASE, CINAHL, SCI/SSCI were searched in December 2010. Only MeSH terms relating to labor analgesia and neuraxial anesthetic techniques were combined with text searches for “intermittent” and “automated” and relevant synonyms, combined with a sensitive methodological filter. Only published RCT’s comparing IEB to CEI for labor analgesia were considered. Primary outcomes included patient satisfaction, anesthesia interventions, and mode of delivery. Two authors extracted data independently. Each author assessed the risk of bias of all included studies using criteria adapted from Furlan et al.(2) All data was transcribed to RevMan 5 for meta-analysis using a random-effects model. Data is reported as mean difference (MD) or Odds Ratios (OR) with 95 % CI.
RESULTS: Eight suitable RCT’s were identified.(3-10) All eight studies were deemed to be a low-risk of bias. None of the studies reported a significant difference in the rate of cesarean delivery or instrumental delivery between the two epidural administration methods. Pooled analysis showed a similar result. IEB resulted in a significant reduction in the number of anesthesia interventions (OR 0.56 95% CI [0.29, 1.06]). The time to a subject’s first anesthetic intervention was not significantly different between groups. There was no significant difference in the total dose of local anesthetic given. Maternal satisfaction was reported by five studies using a 100 mm VAS collected after delivery. Pooled results showed a significantly greater satisfaction score for those in the IEB groups (Figure).
DISCUSSION: IEB dosing of labor epidurals may be associated with improved maternal satisfaction and less anesthetic interventions compared to CEI analgesia. However mode of delivery was not significantly different between the two modes of administration.
1. Anaesthesia 1988;43, 2. Spine 2009;34, 3. Anesth Analg 2006;102, 4. Anesth Analg 2007;104, 5. Obstet Gynecol 2005;106, 6. Int J Obstet Anesth 2005;14, 7. Anaesth Intensive Care 2010;38, 8. Int J Obstet Anesth 2010;19, 9. Br J Anaesth 2006;97, 10. Can J Anaesth 2004;51