A Randomized Comparison of Programmed Intermittent Epidural Bolus with Continuous Epidural Infusion

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A Randomized Comparison of Programmed
Intermittent Epidural Bolus with Continuous
Epidural Infusion for Labor Analgesia

• AA Volume 102(3), March 2006, pp 904-909

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Content

• Abstract
• Method
• Result
• Discussion

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Abstract

• Bolus vs continuous infusion
• Satisfaction
• Workload
• Anesthetic dose
• Motor block sensory level

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Methods

• Material
• Healthy
• Singleton
• Vertex pregnancy
• Scheduled for induction
• Time to set the epidural cath.
• Cervical dilation 2-5cm
• L3-4/L2-3
• Bupivacaine 1.25mg and Fentanyl 15ug injected
  intrathecally,??4-5cm with 1.5 Lidocaine 3ml via
  EA
• ? randomized to PIEB and CEI

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Methods

• Concentration of the solution Bupivacaine 0.625
  mg/ml and Fentanyl 2ug/ml
• 3way
• PIEB 6-mL bolus at a rate of 400 mL/h every 30
  min beginning 45 min after the intrathecal
  dose
• CEI continuous infusion at 12 mL/h beginning 15
  min after the intrathecal dose
• PCEA pump deliver 5 mL bolus dose with a lockout
  interval of 10 min and four hour
  limited 15 mL
• Discontinued infusion completion of the perineal
  
  repair

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Methods

• VAS
• Bromage score
• 0 no impairment
• 1 unable to raise extended leg but able to move
  knees and feet
• 2 unable to raise extended leg as well as flex
  knees, able to move foot
• 3 not able to flex ankle, feet or knees

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Methods

• The primary outcome bupivacaine consumption per
  hour
• Secondary outcome labor pain

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Results
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Discussion

• PIEB combined with PCEA resulted in less
  bupivacaine consumption compared with CEI plus
  PCEA
• That patient satisfaction was higher with PIEB
  compared with CEI analgesia

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Discussion
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Discussion

• Intermittent manual bolus injection? dose-sparing
• Disadvantages
• Contamination ? system is opened
• May lead drug error
• Wider variation in pain relief
• PIEB 6-mL bolus at a rate of 400 mL/h every 30
  min beginning 45 min after the intrathecal dose

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Disscusion

• Reason of bolus group is more satisfied than
  continuous group
• epidural set multiorifice set
• The distribution of solution
• high injectate pressure

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Thanks for your attention