Continuous epidural infusion versus programmed intermittent epidural bolus for labor analgesia: optimal configuration of parameters to reduce physician-administered top-ups.

Continuous epidural infusion versus programmed intermittent epidural bolus for labor analgesia: optimal configuration of parameters to reduce physician-administered top-ups. Curr Med Res Opin. 2017 Sep 06;:1-18 Authors: Delgado C, Ciliberto C, Bollag L, Sedensky M, Landau R Abstract BACKGROUND AND OBJECTIVES: Programmed intermittent epidural bolus (PIEB) is a delivery mode associated with decreased local analgesia dosing, motor block, and physician-administered top-ups (PATU) during labor analgesia. We hypothesized that PIEB delivery at different settings will result in fewer PATU for labor analgesia than the same hourly volume of a continuous epidural infusion (CEI). METHODS: 'Before and after' study design of combined-spinal epidural (CSE) for labor, with bupivacaine 0.0625%-fentanyl 2mcg/ml and patient-controlled epidural analgesia (PCEA; 5ml bolus with 10min lockout). The 'before' group (N = 120) received a CEI at 10ml/hour. PIEB groups received a programmed bolus of 10mL: every 60min (PIEB60, N = 120), every 45min (PIEB45, N = 140), or every 45min with high flow (500ml/hour) (PIEB45HF, N = 25). MAIN OUTCOME MEASURES: Number of women requesting a PATU, time intervals from CSE to PATU and to delivery, and obstetric outcomes. RESULTS: There was no difference in proportion of women requesting PATU between CEI and PIEB60 groups (45/120 versus 52/120, respectively; p > 0.0...
Source: Current Medical Research and Opinion - Category: Research Tags: Curr Med Res Opin Source Type: research

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