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Programmed Intermittent Epidural Boluses Implementation for Labor Analgesia: A Retrospective Impact Analysis
Abstract Number: F-17
Abstract Type: Original Research
Introduction: Randomized controlled trials have demonstrated that programmed intermittent epidural boluses (PIEB) compared to continuous epidural infusion (CEI) reduce epidural local anesthetic consumption and increase maternal satisfaction with labor analgesia. [1,2] The aim of the study was to compare labor analgesic outcomes before and after the implementation of PIEB for labor analgesia in a busy academic hospital.
Methods: We conducted a quality assurance retrospective analysis before and after replacing the background CEI with PIEB for patient-controlled epidural labor analgesia (PCEA). Pre-PIEB pump setting: CEI 12 mL/hr with PCEA 12 mL every 15 mins. Post-PIEB setting: 8mL bolus every 45 mins with PCEA dose of 10 mL every 15 mins. At our institution, labor analgesia is initiated with either 15 mLs of epidural bupivacaine 0.125% + sufentanil 10 mcg or with intrathecal bupivacaine 2.5mg + sufentanil 5mcg for a combined spinal-epidural (CSE) technique. Our maintenance solution is bupivacaine 0.0625% + sufentanil 0.4 mcg/mL. We reviewed medical records of all women receiving epidural/CSE labor analgesia for 30 days before and after PIEB was introduced. Data collected included: parity; labor type; pain scores; physician top-ups; and timing of initial physician top-up. We excluded women with failed epidural or CSE blocks.
Results: Labor initiation technique (CSE/epidural), physician top-ups (number, total dose, and timing of initial intervention), and maximum pain scores post labor analgesia of the two groups were compared. (Table 1) We found no difference in any labor analgesic outcomes before and after PIEB implementation. Parity, CSE technique, and oxytocin administration for induction/augmentation were similar between the groups (Table 1).
Conclusions: Despite reducing our background dose (approximately 10ml/h with PIEB compared to 12 ml/h with CEI) and decreasing the PCEA dose (10 vs. 12 ml) we found that PCEA + PIEB provided similar analgesia compared to PCEA + CEI. The optimal PIEB with PCEA setting remains unclear. (2) This initial impact study analysis following the introduction of PIEB confirms potential local anesthetic sparing without compromising labor analgesia, however benefits appear to be modest.
1. Anesth Analg 2013; 116(1); 133-134
2. Anesth Analg 2011; 112(4); 904-911