Comparison of Intermittent Bolus and Continuous Infusion of 0.1% Levobupivacaine With Fentanyl for Epidural Labor Analgesia

Abstract

Objectives: This study was carried out to compare intermittent bolus and continuous infusion for epidural labor analgesia in terms of total dose requirement of local anesthetic and quality of analgesia as primary objective. Secondary objective was level of sensory block, motor block, hemodynamic variables, mode of delivery, duration of second stage, neonatal outcome, side effects, and postpartum complications. Methods: Eighty women of ASA physical status I or II, with single pregnancy, cephalic presentation and cervical dilatation 3–5 cm, that is, during active labor were included in the study. Patients were randomly divided into two groups. In Group A, a bolus of 8 ml of 0.1% levobupivacaine (plain) with fentanyl 2 mcg/ml was given every hour and in Group B, an infusion of 0.1% levobupivacaine (plain) with fentanyl 2 mcg/ml at 8 ml/h was given. Pain scores using visual analog scale and verbal rating score, additional bolus requirement and total dose of local anesthetic, motor blockade, fetal and neonatal outcome, mode of delivery, and duration of second stage were recorded and compared. Side effects and postpartum complications if any were documented. Results: Additional bolus requirement and total dose of local anesthetic were significantly high in Group B (45.60±6.67 mg) as compared to Group A (34.20±5.58 mg). There was no difference in the quality of analgesia, neonatal outcome, mode of delivery, duration of second stage, side effects, and complications. Conclusion: Intermittent epidural bolus is better in terms of less drug consumption and less number of additional bolus requirement.