A Comparison of Minimum Local Anesthetic Volumes and Doses of Epidural Bupivacaine (0.125% w/v and 0.25% w/v) for Analgesia in Labor

Lyons, G.; Kocarev, Mitko; Wilson, Robert R.; Columb, Malachy O.

doi:10.1213/01.ane.0000252458.20912.ef

Cited by 45 publications

(14 citation statements)

References 11 publications

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“…This may have some influence on labor analgesic outcomes, since larger boluses of more dilute LA may have improved spread in the epidural space, resulting in enhanced analgesia of longer duration and increased patient satisfaction 15,16 . Thus, while our current results differed from what has been shown in previous reports, the conclusions must be interpreted in the context of these potential differences.…”

Section: Discussionmentioning

confidence: 99%

A retrospective comparison of programmed intermittent epidural bolus with continuous epidural infusion for maintenance of labor analgesia

Tien

Allen

Mauritz

et al. 2016

Current Medical Research and Opinion

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Objective To assess whether maintenance of labor epidural analgesia using programmed intermittent epidural bolus (PIEB) is associated with reduced local anesthetic (LA) consumption, patient-controlled epidural analgesia (PCEA) use, and rescue analgesia requirements compared to continuous epidural infusion (CEI). Research Design and Methods This is a retrospective study at an academic university medical center. Women receiving epidural labor analgesia from March-July of 2015 were identified and categorized into three groups: 1) CEI 5 mL/hr, 2) PIEB 5 mL/60 minutes, 3) PIEB 3 mL/30 minutes. The LA consisted of bupivacaine 0.125 mg/mL and fentanyl 2 µg/mL. All patients had similar PCEA settings. Data were collected on pattern of LA usage, obstetric outcomes and Bromage scores. Main Outcome Measures The primary endpoint was total volume of LA consumed/hour. Secondary outcomes included need for clinician boluses, pattern of PCEA use, degree of motor blockade and delivery mode. Results We included 528 patients (262 had CEI, 162 had PIEB 5 mL/60 minutes, and 104 had PIEB 3 mL/30 minutes). Median LA consumed was 10.3, 9.5, and 9.7 mL/hr, respectively (p=0.10). There were no differences in PCEA attempts or rescue clinician boluses, but PCEA volume (p=0.03) and ratio of PCEA attempts/given (p<0.01) were significantly different among the groups. Patients receiving PIEB 3 mL/30 minutes used lower PCEA volume than patients receiving CEI (p=0.04). Patients with PIEB 5 mL/60 minutes and PIEB 3 mL/30 minutes had higher ratio of PCEA attempts/given than CEI patients (p=0.01 and p<0.01, respectively). There were no differences in Bromage scores (p=0.14) or delivery mode (p=0.55) among the groups. Conclusions The epidural maintenance regimen used (CEI vs. PIEB) was not associated with differences in LA consumption, motor blockade or delivery mode. Main limitations of the study include its single center retrospective design and the fact that patients were not randomized to treatment groups.

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Section: Discussionmentioning

confidence: 99%

A retrospective comparison of programmed intermittent epidural bolus with continuous epidural infusion for maintenance of labor analgesia

Tien

Allen

Mauritz

et al. 2016

Current Medical Research and Opinion

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“…It is possible that longer lockout times with no background infusion or small bolus doses may not allow the agents to disperse adequately; several investigations have indicated that the dose and volume of the bolus injection is important for effective PCEA labor analgesia. 16,17 Furthermore, longer lockout times may induce more frequent bolus demands without delivery of agents because the request occurred within the lockout time interval. 14 With the agents and doses used in our study, a 10-min lockout interval when using a continuous background infusion may represent optimal settings for labor analgesia without increasing the total local anesthetic and opioid consumption.…”

Section: Discussionmentioning

confidence: 99%

A double-blind randomized controlled trial of patient-controlled epidural analgesia with or without a background infusion following initial spinal analgesia for labor pain

Okutomi

Saito

Mochizuki

et al. 2009

International Journal of Obstetric Anesthesia

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“…[24] in their comparative study sought to determine the minimum local analgesic volume (MLAV) and minimum local analgesic dose (MLAD) of an initial bolus of epidural bupivacaine 0.125% and 0.25%. The MLAV of bupivacaine 0.125% was 13.6 ml (95% CI 12.4–14.8) versus 9.2 ml (95% CI 6.9–11.5) for bupivacaine 0.25% ( P = 0.002).…”

Section: Technical Advancesmentioning

confidence: 99%

Labour analgesia: Recent advances

Pandya

2010

Indian J Anaesth

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Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients. Technological advances like use of ultrasound to localize epidural space in difficult cases minimizes failed epidurals and introduction of novel drug delivery modalities like patient-controlled epidural analgesia (PCEA) pumps and computer-integrated drug delivery pumps have improved the overall maternal satisfaction rate and have enabled us to customize a suitable analgesic regimen for each parturient. Recent randomized controlled trials and Cochrane studies have concluded that the association of epidurals with increased caesarean section and long-term backache remains only a myth. Studies have also shown that the newer, low-dose regimes do not have a statistically significant impact on the duration of labour and breast feeding and also that these reduce the instrumental delivery rates thus improving maternal and foetal safety. Advances in medical technology like use of ultrasound for localizing epidural space have helped the clinicians to minimize the failure rates, and many novel drug delivery modalities like PCEA and computer-integrated PCEA have contributed to the overall maternal satisfaction and safety.

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A Comparison of Minimum Local Anesthetic Volumes and Doses of Epidural Bupivacaine (0.125% w/v and 0.25% w/v) for Analgesia in Labor

Abstract: Bupivacaine 0.125% (w/v) when compared with 0.25% (w/v) produced equivalent analgesia with a 50% increase in volume, but with a 25% reduction in dose. Any reduction in dose, without loss of efficacy, reduces risk of toxicity and improves safety.

Cited by 45 publications

References 11 publications

A retrospective comparison of programmed intermittent epidural bolus with continuous epidural infusion for maintenance of labor analgesia

A retrospective comparison of programmed intermittent epidural bolus with continuous epidural infusion for maintenance of labor analgesia

A double-blind randomized controlled trial of patient-controlled epidural analgesia with or without a background infusion following initial spinal analgesia for labor pain

Labour analgesia: Recent advances

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