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A retrospective cohort assessment of the impact of programmed intermittent epidural bolus compared to continuous epidural infusion for labour analgesia
Abstract Number: T210-287
Abstract Type: Original Research
Background: Programmed intermittent epidural bolus (PIEB) is the next evolution of labor analgesia that may replace continuous epidural infusion (CEI). PIEB may result in a decreased amount of local anesthetic consumption, decreased duration of second stage of labor, and potential reduction in instrumental vaginal delivery (IVD) rates.(1) At the authors’ institution the primary method of labor analgesia was CEI in conjunction with PCEA. Since 2015, PIEB with PCEA has been exclusively offered for labor analgesia. The goal of this study is to evaluate the impact on obstetrical outcomes after the institutional change in labor analgesia from CEI to PIEB.
Methodology: With institutional ethics and data access approval, a population-based cohort analysis was conducted using data from a provincially validated database. This database collects information on all pregnancy outcomes from our institution. Information on patient demographics, such as maternal age, gestational age, length of second stage of labor, fetal outcomes and mode of delivery are available. The study population included parturients with term, singleton pregnancies of vertex presentation, receiving epidural labor analgesia, that delivered at the authors’ institution in 2014 (CEI) or 2017 (PIEB).
Results: The sample includes 7,967 patients; 4,299 who delivered in 2014 with CEI and 3,668 who delivered in 2017 with PIEB (Table 1). The patients were demographically similar except for parity and race/ethnicity. Patients in the CEI cohort less frequently had labor induced or augmented. The cesarean delivery rate was similar in each cohort. CEI was associated with lower IVD rates for forceps and vacuum deliveries. The second stage of labor was shorter compared with PIEB. The PIEB cohort experienced more perineal injuries.
Conclusions: Despite initial evidence suggesting possible improved analgesia with less motor blockade and possibly reduced IVD, institutional data from real life implementation suggests PIEB is associated with higher rates of IVD.
1. Anesth Analg 2013;116:133-44