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A Comparison of Epidural Infusion Strategies for Labor Analgesia
Abstract Number: F-70
Abstract Type: Original Research
Background: Epidural analgesia has long been considered the optimal technique for control of labor pain. There is no conclusive evidence regarding the most effective dosing strategy that will minimize drug consumption while maintaining effective analgesia. The purpose of this study was to compare the effectiveness of three epidural infusion strategies for labor analgesia and to test the hypothesis that a lower basal rate with a higher patient controlled bolus will result in lower analgesic consumption.
Methods: In a randomized single-blind study, 120 laboring parturients received epidural analgesia using a standard solution of 0.125% bupivacaine with 2mcg/ml fentanyl and received the following infusion strategies: group 1: 12mL patient controlled bolus every 20 minutes with 4mL/hr basal rate; group 2: 8mL patient controlled bolus every 15 minutes with 7mL/hr basal rate; group 3: 5mL patient controlled bolus every 10 minutes with 10mL/hr basal rate.
Results: Mean hourly analgesic volumes for groups 1, 2 and 3 were 12.3 (SD 3.2), 14.5 (SD 4.9), and 15.7 (SD 4.4), respectively. Group 1 had significantly less analgesic consumption than groups 2 and 3 (p’s<0.05). Mean Verbal Numeric Rating Scale (VNRS) scores at time 0 for groups 1, 2 and 3 were 7.29 (SD 2.1), 7.430 (SD 2.16), 6.36 (SD 2.58), respectively. Following epidural placement, VNRS scores on average ranged from 1 to 4 with no statistical significance between groups (p>0.05). Median Modified Bromage scores were 0 and 1 across all times; there was no statistical significance between groups (p>0.05).
Conclusions: Analysis shows no difference in pain scores, modified Bromage scores, requests for supplemental analgesia, or epidural pump delivery/demand data. Mean hourly analgesic volumes indicate that an epidural dosing regimen of an available 12 mL patient controlled bolus every 20 minutes with a 4mL/hr continuous epidural infusion is effective at reducing total analgesic consumption while providing equipotent analgesia.
Keywords: Bupivacaine, Epidural Analgesia, Labor Pain, Pain Management, Pregnancy