Techniques for the maintenance of epidural labor analgesia

Abstract

Technology has now provided us with more advanced drug delivery systems that may have the potential to fulfill the maternal requirements of a safe, natural, and painless childbirth, tailoring the analgesic regimen for each parturient's need.

The Value of Programmed Intermittent Epidural Bolus in Labor Analgesia

“…Pelvic floor muscles relaxation help cervical dilation and fetal head drop, all at the same time because of pain relief, lower the maternal physical consumption, more physical promotion for the process of delivery, and improve the vaginal births, reduce the complications incidence of the mother and neonate, which is benefit for mother and neonate [8][9][10]. Labor analgesia had been used for many years, doctors and researchers had wondered which mode is better for clinical practice [11].…”

Geburtshilfliche Anästhesie Teil 2: Etablierte Standards und neue Perspektiven

“…Hierbei wird die Hintergrundinfusion nicht kontinuierlich, sondern stündlich als programmierter Bolus verabreicht. Dies führt wahrscheinlich zu einer verbesserten epiduralen Verteilung des Lokalanästhetikums und verhindert einen Konzentrationseffekt, was wiederum das Risiko motorischer Blockaden vermindert [3].…”

Impact of Drug Delivery Systems on Neuraxial Labor Analgesia

“…Higher infusion rates decreased the need for rescue boluses but resulted in greater incidence of motor block in parturients [10,12,13]. This occurred despite the use of low-dose epidural infusion in response to the findings of the landmark COMET trial conducted in the United Kingdom [14].…”

“…However, the disadvantages of these intermittent, irregular 'top-ups' for the maintenance of labor analgesia were soon recognized, the most significant of these was the waning of analgesic effect and the return of pain before the next dose of local anesthetic [10]. Other concerns included repeated injections causing sudden increase in sympathetic blockade, increased risk of a total spinal or local anesthetic toxicity [11].…”

“…In this study, solutions of different strengths were used in the two pumps (0.125 % levobupivacaine for PCEA pump and 0.0625 % levobupivacaine with sufentanil 0.5 mcg/ml for the AMB and CEI pump). Capogna and Stirparo [10] had previously noted that a high rate of breakthrough pain requiring clinician intervention was recorded in studies using the same concentration of local anesthetic for both PCEA and AMB boluses. While assembling a dual pump set-up is technically easier than integrating computer systems into infusion pumps, the lack of communication between PCEA and the AMB (or CEI) modes in a dual pump set-up may risk a large volume bolus being delivered to the patient if the PCEA bolus and AMB are activated at the same time.…”