Patient intermittent epidural boluses (PIEB) plus very low continuous epidural infusion (CEI) versus patient-controlled epidural analgesia (PCEA) plus continuous epidural infusion (CEI) in primiparous labour: a randomized trial

Rodríguez-Campoó, Maria Belen; Curto, Antonio; González, Manuel; Aldecoa, César

doi:10.1007/s10877-018-0229-x

Cited by 15 publications

(19 citation statements)

References 38 publications

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“…It is used only as an alternative to CEI or as part of a background infusion of local anesthesia in PCEA labor analgesia techniques. Previous randomized controlled trials (5,6) have shown that using a PIEB instead of background infusion can reduce the consumption of local anesthetics as well as the incidence of maternal motor block and breakthrough pain, thus making the need for anesthesiologist rescue supplements less urgent. Recently, the dural puncture epidural (DPE) technique has attracted increasing research attention and popularity due to its improved blocking and fewer side effects in the obstetric population (7,8).…”

Section: Introductionmentioning

confidence: 99%

A randomized trial of the dural puncture epidural technique combined with programmed intermittent epidural boluses for labor analgesia

Wang¹,

Zhang²,

Zheng³

et al. 2021

Ann Palliat Med

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Background: Continuous epidural infusion (CEI) can provide analgesia during labor. The dural puncture epidural (DPE) technique is used to accelerate the onset of neuraxia anesthesia. The primary objective of this study was to compare the percentage of patients that received adequate labor analgesia following an injection of 0.08% epidural ropivacaine via the DPE and CEI techniques combined with the PIEB mode of maintenance.Methods: Patients who were laboring were randomly allocated to receive either CEI + PIEB or DPE + PIEB. Subjects indicated a VAS score immediately prior to epidural placement, and parturients with a VAS score of ≤50 mm were excluded. A 25-gauge needle was used for dural puncture. Analgesia was provided with 10 mL of 0.08% ropivacaine and 0.4 μg/mL of sufentanil, and was maintained at 10 mL/h in both groups with the same solution. All pumps were programmed for patient-controlled epidural analgesia (PCEA) boluses of 5 mL with a 20-minute lockout. VAS measurements were collected at 2-minute intervals for up to 20 minutes after initiation of the epidural bolus. The median time to adequate analgesia was analyzed using Kaplan-Meier curves and Cox proportional hazard models.Results: Data were collected and analyzed from 200 participants (n=100 per group). Adequate analgesia at 10 minutes was higher in the DPE + PIEB group compared to the CEI + PIEB group (DPE + PIEB =58.4% vs. CEI + PIEB =41.6%; P=0.007). The DPE + PIEB group also had a shorter median time to adequate analgesia [median (95% confidence interval (CI), 8 minutes (7-9 minutes) vs. 12 minutes (10-14 minutes)] compared to the CEI + PIEB group [hazard ratio (HR) =1.488; 95% CI, 1.105-2.002; P=0.002].

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Section: Introductionmentioning

confidence: 99%

A randomized trial of the dural puncture epidural technique combined with programmed intermittent epidural boluses for labor analgesia

Wang¹,

Zhang²,

Zheng³

et al. 2021

Ann Palliat Med

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“…Other novel techniques, such as the addition of a low-dose continuous infusion to IEB, 90,91 may also have a role in remedying this possible shortcoming of IEB in the early period.…”

Section: Ieb Approachmentioning

confidence: 99%

Comparative analgesic efficacy and safety of intermittent local anaesthetic epidural bolus for labour: a systematic review and meta-analysis

Hussain

Lagnese

Hayes

et al. 2020

British Journal of Anaesthesia

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Background: Continuous epidural infusion (CEI) is commonly used for labour analgesia, but concerns over potential motor block, second-stage labour complications, and ineffective analgesia in late labour have prompted examining intermittent epidural bolus (IEB) as an alternative. However, evidence comparing these modalities is conflicting. The meta-analysis evaluates the analgesic efficacy of CEI vs IEB. Methods: Databases were searched for trials comparing CEI to IEB for labour analgesia. The two co-primary outcomes were risk of breakthrough pain and difference in area under the curve (AUC) for pain scores during the first 4 h postepidural initiation. Local anaesthetic consumption, maternal outcomes (i.e. delivery mode, labour duration, and maternal satisfaction), and side-effects of epidural analgesia were also evaluated. Results were pooled using randomeffects modelling. Trial sequential analysis (TSA) was used to evaluate evidence reliability. Results: Twenty-seven studies (3133 patients) were analysed. Compared with CEI, IEB decreased risk of breakthrough pain by 38% (risk ratio [95% confidence interval {CI}] of 0.62 [0.48, 0.81]; P¼0.0004; I 2 ¼47%; 1164 patients) and reduced AUC of pain during the 4 h interval by 32.9% (mean difference [95% CI] of e16.7 mm h À1 [e18.9, e14.4]; P<0.0001; 1638 patients). Intermittent epidural bolus enhanced maternal satisfaction, shortened labour duration, decreased motor block, and reduced local anaesthetic consumption. The difference between the two groups was not statistically significant for epidural side-effects or mode of delivery. The TSA indicated adequate power for reliable inferences. Conclusions: Intermittent epidural bolus provides improved labour pain control during the first 4 h after epidural initiation with less breakthrough pain. Moderate-to high-quality evidence of intermittent epidural bolus superiority support its use as a safe and effective continuous epidural infusion alternative for labour analgesia.

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“…ere are several methods to offer postoperative analgesia for abdominal surgery, oral analgesics, patient-controlled intravenous analgesia (PCIA), patient-controlled epidural analgesia (PCEA), and regional nerve block [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…PCEA plays a direct role in the near operative region and possesses a more immediate analgesic mechanism; thus, it could offer fast, clear, and accurate analgesic effect and reduce the use of opioids. PCEA seems to be an ideal method for postoperative pain control; it could be demonstrated to have a good postoperative analgesic effect in many common operations such as abdominal and gynecological surgeries [3,4]. PCIA acts on the whole body through intravenous analgesics with relatively longer and more rapid analgesic effect with the PCA device.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Analgesic Effect between Preoperative and Postoperative Transversus Abdominis Plane (TAP) Blocks for Different Durations of Laparoscopic Gynecological Surgery

Wei

Liu

et al. 2021

Scientific Programming

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Aim. This study aims to compare the postoperative analgesia between preoperative and postoperative ultrasound-guided transversus abdominis plane (TAP) blocks for different durations of laparoscopic gynecological surgery. Methods. A total of 120 patients, ASA I-III, 18–65 years of age, were divided randomly into 2 groups: preoperative TAP group (pre-TAP group) and postoperative TAP group (post-TAP group). Patients in the pre-TAP group (n = 60) and post-TAP group (n = 60) received bilateral TAP blocks of 0.375% ropivacaine, 40 mL, preoperatively and postoperatively, respectively. Duration of surgery, postoperative pain score, consumption of analgesics, and postoperative nausea and vomiting (PONV) during the first 24 h postoperatively were recorded. Results. For all the patients in the two groups, similar analgesia was obtained with no statistical difference. The same results were found in duration of surgery <180 min. Meanwhile, patients undergoing surgery >180 min in the post-TAP group obtained lower postoperative pain score, lower analgesics consumption, and higher satisfaction score than those in the pre-TAP group. Conclusion. Postoperative TAP block could offer better postoperative analgesia than preoperative TAP block for patients undergoing surgery >180 min. No difference was found in analgesia effect between preoperative TAP block and postoperative TAP block for patients undergoing surgery <180 min.

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Patient intermittent epidural boluses (PIEB) plus very low continuous epidural infusion (CEI) versus patient-controlled epidural analgesia (PCEA) plus continuous epidural infusion (CEI) in primiparous labour: a randomized trial

Cited by 15 publications

References 38 publications

A randomized trial of the dural puncture epidural technique combined with programmed intermittent epidural boluses for labor analgesia

A randomized trial of the dural puncture epidural technique combined with programmed intermittent epidural boluses for labor analgesia

Comparative analgesic efficacy and safety of intermittent local anaesthetic epidural bolus for labour: a systematic review and meta-analysis

A Comparison of Analgesic Effect between Preoperative and Postoperative Transversus Abdominis Plane (TAP) Blocks for Different Durations of Laparoscopic Gynecological Surgery

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