Effect of programmed intermittent epidural boluses and continuous epidural infusion on labor analgesia and obstetric outcomes: a randomized controlled trial

Abstract

Our study evidenced a lower anesthetic consumption in the programmed intermittent boluses group with similar labor analgesic control, and obstetric and newborn outcomes in both groups.

Pain management during labor: use of intermittent drug delivery devices for improvement of obstetric and neonatal outcome and reduction of healthcare burden: A large non-inferiority randomized clinical trial

“…However, in those trials, the rate of spontaneous vaginal delivery ranged between 30 and 70% of total births [12,14], whereas in our trial, the PIEB protocol was comparable to top-up protocol with > 70% of spontaneous vaginal deliveries. Interestingly, the above trials reported lower average pain scores than ours, while in trials focused on motor blockade and obstetric outcome, the average pain score was similar to our data [6,7,13,[15][16][17]. The NRS threshold of 5 used in our trial was the common threshold in the participating centers before the trial and discussed with parturients during consent acquisition for the procedure.…”

“…The obstetric benefits provided by the PIEB technique in comparison to epidural continuous infusion have been previously reported [11][12][13][14]. However, in those trials, the rate of spontaneous vaginal delivery ranged between 30 and 70% of total births [12,14], whereas in our trial, the PIEB protocol was comparable to top-up protocol with > 70% of spontaneous vaginal deliveries.…”

“…To overcome the risks related to continuous infusion, the administration of intermittent boluses by automatic infusion pumps has recently been proposed with promising results [11][12][13]. Unfortunately, no data are available for the safety comparison between intermittent doses performed by anesthetists (top-up) or by automated devices, associated or not to patientcontrolled administration.…”

Epidural bolus versus continuous epidural infusion analgesia on optic nerve sheath diameter in paediatric patients: A prospective, double-blind, randomised trial

“…After posterior spinal fusion for adolescent idiopathic scoliosis, cumulative opioid consumption is lower when the intermittent bolus function is used than with the continuous infusion mode; rates of postoperative nausea, vomiting and pruritus are much greater when the continuous infusion mode is used 11 . Use of programmed intermittent epidural bolus reduces anaesthetic consumption during labour analgesia and decreases labour pain and motor block 9,10,21,22 . However, bolus injection into a confined space may increase epidural pressure and intracranial pressure, especially in children.…”

Efficacy of aromatherapy to reduce labor pain

“…The authors performed a randomized controlled trial on 104 patients undergoing labor and concluded that aromatherapy is helpful in reducing pain in latent and early active phase, and may be used as an adjunctive method for labor pain control without serious side effects. The authors should be commended for performing a well-designed study in an important topic (e.g., acute pain) in patients undergoing labor [2,3]. In addition, the current emphasis on the need to reduce the use of opioids using multimodal analgesic strategies makes the topic very relevant in obstetric medicine [4,5].…”