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A Comparison of Programmed Intermittent Epidural Boluses to Continuous Epidural Infusion on Laboring Parturients
Abstract Number: S1B-1
Abstract Type: Original Research
Epidural analgesia for labor is often performed using a solution of local anesthetic with opioid delivered by a continuous infusion. Recently programmed intermittent epidural boluses (PIEB) have become more popular. PIEB protocols have shown decreased motor block, increased efficacy of analgesia, and decreased breakthrough pain. While previous studies have evaluated epidural continuous infusions with or without patient controlled demand boluses, limited data exists to evaluate PIEB protocols for labor analgesia. The purpose of this study is to evaluate the effectiveness of different protocols of PIEB with regards to labor analgesia, degree of motor blockade, and frequency of break through pain requirements in nulliparous and multiparous parturients.
We performed a prospective randomized single blinded control trial comparing the effects of three groups of epidural infusion protocols in paturients presenting to labor and delivery for an induction of labor. Epidural solution contained bupivicaine 0.125% with 2mcg/mL fentanyl. Patients randomized to group 1 received a 5 mL programmed bolus of the epidural solution every 30 minutes, group 2 received a 10 mL programmed bolus of the solution every 60 minutes, and group 3 received a 10 mL/hr continuous infusion of the epidural solution.
151 patients were recruited from June 2015 to June 2017. All three groups were comparable with regards to demographic and labor parameters (p>0.05). Total pain over the duration of labor measured by area under curve (AUC, pain scores vs. time) was not different among the three groups. The AUC, when normalized with the duration of labor, showed a trend to be lower in Group 1 compared to both other groups, although not statistically significant (p-value 0.44).
In addition, although not statistically significant, a higher fraction of patients in Groups 2 and 3 had a higher maximum Bromage motor block (defined as Grade of 2 or 3) compared to Group 1 (pvalue 0.24). Interestingly, none of the patients in Group 1 obtained a motor blockade of Grade 3.
Furthermore, there was a non-significant trend towards fewer patients requiring breakthrough medication in Group 1 compared to Groups 2 and 3 (Group 1: 19patients(38%), Group 2: 26 patients(51%), Group 3: 24 patients(48%).
This study shows that all three epidural protocols provided similar labor analgesia. Although, there were no significant differences between the three treatment groups, there was a trend towards overall favorable pain control and less motor blockade associated with receiving analgesic drug at 5ml programmed bolus every 30 minutes. We did notice a clinically significant decrease in motor blockade and physician intervention with manual boluses with the 5 mL programmed bolus every 30 min protocol. Further studies are needed to further evaluate the benefit of the PIEB for labor analgesia.