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Programmed intermittent epidural bolus analgesia for labour: a comparison of two regimens
Abstract Number: T 9
Abstract Type: Original Research
Introduction: Manipulation of the programmed intermittent epidural bolus (PIB) time interval and injection volume can reduce local anaesthetic (LA) consumption without decreasing patient satisfaction . We adjusted the volume and PIB interval to evaluate the effect on LA consumption, using novel technology that delivers both PIB and patient controlled epidural analgesia (PCEA) boluses of low dose epidural mixture (LDM), consisting of 0.1% bupivacaine with 2μg/ml fentanyl at a high flow rate.
Methods: A regimen of 8ml PIB with 45 minutes bolus interval and PCEA 5ml, for breakthrough pain, with 20 minutes lockout (PIB 8/45) was evaluated over a three month period. The regimen was then revised to 5ml PIB with 60 minutes bolus interval and 5ml PCEA with 20 minutes lockout (PIB 5/60). This regimen was evaluated over two months. Pain and motor block were assessed throughout labour and patients were followed up after delivery. The primary outcome measure was LA consumption, while secondary outcomes included motor block, pain scores (0-10) and patient satisfaction. Patients were considered to have a motor block if they had little or no leg movement. Maternal satisfaction was considered adequate if it was reported as 'good', 'very good' or 'excellent'.
Results: Data were evaluated from 86 parturients using PIB 8/45 and 49 parturients using PIB 5/60. Please see table.
Discussion: Our results show that the PIB 5/60 regimen significantly reduced total anaesthetic consumption but had no effect on motor block. Patient satisfaction remained the same in both groups, despite an increase in PCEA use. Our study suggests that further work is required to investigate other factors that may contribute to motor block, such as bupivacaine concentration in the LDM and epidural flow rate.
1. Wong CA, McCarthy RJ, Hewlett B. The effect of manipulation of programmed intermittent bolus time interval on total drug use on labor analgesia: a randomized controlled trial. Anesthesia & Analgesia 2011; 112: 904-11.