A prospective, randomized, blinded-endpoint, controlled study – continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia

Nunes, J.; Nunes, Sara; Veiga, Mariano; Cortez, Mara; Seifert, I.

doi:10.1016/j.bjane.2014.12.006

Cited by 15 publications

(17 citation statements)

References 16 publications

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“…Our study results are consistent with previously published obstetric data showing reduced local anesthetic consumption when using a PIEB technique versus a traditional CEI [ 4 , 7 – 10 ]. However, the overall reduction of LA consumption between the day of operation and POD2 was approximately 15 mL, resulting in questionable clinical relevance.…”

Section: Discussionsupporting

confidence: 93%

Programmed intermittent epidural bolus versus continuous epidural infusion for postoperative analgesia after major abdominal and gynecological cancer surgery: a randomized, triple-blinded clinical trial

et al. 2018

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BackgroundContinuous epidural infusion (CEI) is the standard application setting for epidural infusion. A new mode, the programmed intermittent epidural bolus (PIEB) technique, showed reduced local anesthetic (LA) consumption and improved analgesia in obstetric analgesia. Goal of this trial was to evaluate the effects of PIEB versus CEI [combined with patient-controlled bolus (PCEA)] on LA consumption and pain scorings in major abdominal cancer surgery.MethodsFollowing ethical approval, patients scheduled for major abdominal cancer surgery under general anesthesia in combination with epidural analgesia were randomized to receive either a PIEB mode of 6 mL/h or a CEI mode set at 6 mL/h of ropivacaine 0.2%, both combined with a PCEA mode set at a 4 mL bolus. LA consumptions and pain scorings were documented until the second postoperative evening.ResultsEighty-four datasets were analyzed (CEI: n = 40, PIEB: n = 44). Regarding the primary endpoint, cumulative LA PCEA bolus volumes until day 2 differed significantly between the groups [PIEB 10 mL (2–28 mL) versus CEI, 28 mL (12–64 mL), median (25th–75th percentiles), p = 0.002]. Overall, LA consumption volumes were significantly lower in the PIEB group versus in the CEI group [PIEB: 329 mL (291–341 mL) vs. CEI: 350 mL (327–381 mL), p = 0.003]. Pain scores were comparable at each time point.ConclusionsThis trial demonstrates reduced needs for PCEA bolus in the PIEB group. There were no clinically relevant benefits regarding morphine consumption, pain scorings, or other secondary outcome parameters.Trial registrationThis study has been registered retrospectively in the ClinicalTrials.gov registry (NCT03378804), date of registration: December, 20th 2017.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0613-6) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 93%

Programmed intermittent epidural bolus versus continuous epidural infusion for postoperative analgesia after major abdominal and gynecological cancer surgery: a randomized, triple-blinded clinical trial

et al. 2018

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“…The clear advantage of PIEB delivery for improved maternal satisfaction has been complemented in the most recent studies. One recent study compared maternal satisfaction, with PIEB at different local anesthetic concentrations, to standard CEI in labor analgesia and found that PIEB was associated with equally high maternal satisfaction and no adverse outcomes (14).…”

mentioning

confidence: 99%

Programmed Intermittent Epidural Boluses (PIEB): A Superior Technique for Maitenance of Labor Analgesia

Munro¹,

George²

2017

Turk J Anaesth Reanim

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“…nerves of the uterus, it ensures that the parturient has normal uterine contraction ability [3,4]. At present, most domestic and foreign clinical use of ropivacaine as regional nerve block labor analgesia method can achieve better painless childbirth requirements.…”

Section: Analgesic Efficacy Of Dexmedetomidine Used For Epidural Anesmentioning

confidence: 99%

Analgesic efficacy of dexmedetomidine used for epidural anesthesia on labor analgesia

Wang¹,

Zhengzhuang²,

Ou³

2018

biomedicalresearch

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Objective:Toinvestigatetheanalgesic effect of dexmedetomidine in epidural anesthesia for labor analgesia. Methods: 150 nulliparous patients were randomly divided into two groups with 75 cases each: ropivacaine group (R) and ropivacaine+dexmedetomidinegroup (R+Y). R group received analgesia with 0.1% ropivacaine and R+Y group received 0.1% ropivacaine and 0.5 μg/ml dexmedetomidine. The background infusion 10 ml/h, bonus 5 ml, lockout time 20 min. Vital signs, VAS of pain, progress of labor, neonatal Apgar score, postpartum haemorrhage amount, side effects and serum level of IL-6 and TNF-α were recorded. Results: Heart rate and mean arterial pressure of two groups were decreased after analgesia, but still in the normal range. The total stage of labor of R group was (608.2 ± 98.4 min) longer than the R+Y group. Two groups of total labor have a significant difference, especially in the first and second labor. The VAS score of the two groups all decreased after analgesia, score of R+Y group was lower than the other. There were no significant differences in the side effects, postpartum haemorrhage amount and neonatal Apgar score between the two groups. The serum level of IL-6 and TNF-α in R+Y group were lower than the R group in childbirth and 24 h after it. Conclusion: Dexmedetomidine used for epidural anesthesia on labor analgesia has high effect and safety. It can promote the progress of labor without severe side effects. Combination of ropivacaine +dexmedetomidine is better medicine mode for labor analgesia.

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A prospective, randomized, blinded-endpoint, controlled study – continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia

Abstract: Maintenance of epidural analgesia with programmed intermittent epidural bolus is associated with a reduced incidence of caesarean delivery with equally high maternal satisfaction and no adverse outcomes.

Cited by 15 publications

References 16 publications

Programmed intermittent epidural bolus versus continuous epidural infusion for postoperative analgesia after major abdominal and gynecological cancer surgery: a randomized, triple-blinded clinical trial

Programmed intermittent epidural bolus versus continuous epidural infusion for postoperative analgesia after major abdominal and gynecological cancer surgery: a randomized, triple-blinded clinical trial

Programmed Intermittent Epidural Boluses (PIEB): A Superior Technique for Maitenance of Labor Analgesia

Analgesic efficacy of dexmedetomidine used for epidural anesthesia on labor analgesia

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