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Mobility with programmed intermittent epidural bolus labour analgesia
Abstract Number: T-42
Abstract Type: Other
A new delivery method for labour analgesia combining programmed intermittent epidural boluses (PIEB) with patient controlled epidural analgesia (PCEA) has recently been introduced onto our labour ward. Recent trends have shown that the uptake of PCEA by maternity units is increasing in popularity . Research into PIEB combined with PCEA has shown a reduced incidence of motor block and instrumental delivery . We conducted a service evaluation to investigate maternal motor block and maternal satisfaction with analgesia.
After local audit department approval, prospective data was collected over a one month period from parturients who received PIEB analgesia for labour. The protocol was a PIEB of 7mL of 0.1% levo-bupivacaine with 2microgram/mL fentanyl every hour with a PCEA of 6mL of the same solution, available every 20 minutes.
Following initiation of analgesia, mobility was assessed hourly by the midwife and categorised as one of four options: “walking around”, “sitting/standing”, “mobilising in bed” or “dense motor block”. Mothers were then reviewed on the postnatal ward prior to discharge home and questioned on their satisfaction with their analgesia.
Mobility data was collected on 87 mothers. Of these, 63 were successfully reviewed prior to discharge home and maternal satisfaction for analgesia noted.
Of the 87 patients, 6 (6.9%) had a worst documented mobility of “walking around”, 11 (12.6%) of “sitting/standing”, 68 (78.2%) of “mobilising in bed” and only 2 (2.3%) had a “dense motor block”.
Of the 63 maternal responses at postnatal review for pain relief during labour, 50 (79.4%) were “Very Satisfied”, 13 (20.6%) “Satisfied” and none were “Dissatisfied”. Of the 45 women who had either an instrumental or spontaneous vaginal delivery, 32 (71.1%) were “Very Satisfied” with their pain relief during delivery, 11 (24.4%) were “Satisfied” whilst 2 (4.4%) were “Dissatisfied”.
We have shown this PIEB protocol maintains mobility for the vast majority of our patients. Dense motor block was very uncommon and a large proportion of patients were able to mobilise in bed. Being able to mobilise in bed during labour allows mothers to move into comfortable positions, especially for the delivery of their baby. We also note that maternal satisfaction for analgesia remains excellent. We aim to repeat the audit once PIEB is more firmly established in our unit and mobility is encouraged to a greater extent.
1. M Purvan, B Ramalingam, S Solai. National Obstetric Anaesthesia Data for 2011 – A Report. Obstetric Anaesthetists’ Association.
2. Capogna G et al. Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia: the effects on maternal motor function and labor outcome. A randomized double-blind study in nulliparous women. Anesthesia & Analgesia October 2011; 113(4): 826-31.