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Objective To compare the efficacy of programmed intermittent epidural bolus and continuous epidural infusion of ropivacaine in labor analgesia.Methods From May 2014 to May 2017,170 patients,24 -32 years,for full-term primipara in the Maternal and Child Health Care Hospital of Quzhou were selected as study objects,and they were randomly divided into intermittent epidural injection group (T group) and continuous epidural pump group(C group) by computer random software,with 85 cases in each group.All patients were epidurally injected 2%lidocaine 3mL and 0.2% ropivacaine 2mL at the opening of the uterus,less than 3cm.T group was given programmed intermittent epidural bolus 0.1% ropivacaine 6mL/h.C group was given continuous epidural infusion 0.1%ropivacaine 6mL/h.The pain of maternal(NRS score) and motor block situation of maternal (Bromage score) were monitored.The number of PCEA,PCEA pressure times,the rate of instrumental delivery and APGAR score were also recorded.Results The number of Bromage score≥2 in C group was higher than that of T group at 4-10h after labor analgesia (3 cases vs.11 cases,3 cases vs.15 cases,4 cases vs.17 cases,4 cases vs.18 cases,6 cases vs. 19 cases,6 cases vs.21 cases,7 cases vs.22 cases;χ2＝4.982,8.947,9.182,10.230,7.926,9.907,9.354,all P＜0.05).There was no statistically significant difference in NRS score between the two groups (P＞0.05).The number of PCEA,PCEA pressure times and the rate of instrumental delivery in T group were lower than those in C group [8 cases vs.18 cases,22 cases vs.41 cases,(3.5 ±1.5) times vs.(4.9 ±2.2) times;χ2＝4.541,9.104;t＝2.666,all P＜0.05].There was no statistically significant difference in Apgar score between the two groups (P＞0.05).Conclusion Compared with continuous epidural infusion,programmed intermittent bolus of ropivacaine for labor analgesia exerts good analgesic effect,it has minor effects on exercise function and can decrease the rate of instrumental delivery .
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Abstract Background: There is evidence that administration of a programmed intermittent epidural bolus (PIEB) compared to continuous epidural infusion (CEI) leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. Methods: In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10 mL with Ropivacaine 0.16% plus Sufentanil 10 µg, parturient were randomly assigned to one of three regimens: A - Ropivacaine 0.15% plus Sufentanil 0.2 µg/mL solution as continuous epidural infusion (5 mL/h, beginning immediately after the initial bolus); B - Ropivacaine 0.1% plus Sufentanil 0.2 µg/mL as programmed intermittent epidural bolus and C - Same solution as group A as programmed intermittent epidural bolus. PIEB regimens were programmed as 10 mL/h starting 60 min after the initial bolus. Rescue boluses of 5 mL of the same solution were administered, with the infusion pump. We evaluated maternal satisfaction using a verbal numeric scale from 0 to 10. We also evaluated adverse, maternal and neonatal outcomes. Results: We analyzed 130 pregnants (A = 60; B = 33; C = 37). The median verbal numeric scale for maternal satisfaction was 8.8 in group A; 8.6 in group B and 8.6 in group C (p = 0.83). We found a higher caesarean delivery rate in group A (56.7%; p = 0.02). No differences in motor block, instrumental delivery rate and neonatal outcomes were observed. Conclusions: 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.
Resumo Justificativa: Há evidências de que a administração de um bolus epidural intermitente programado (BEIP) comparada com a infusão epidural contínua (IEC) resulta em maior eficácia da analgesia e da satisfação materna, com redução das intervenções anestésicas. Métodos: Neste estudo, 166 mulheres com gravidezes viáveis foram incluídas. Após uma dose epidural de 10 mL de ropivacaína a 0,16% e adição de 10 µg de sufentanil, as parturientes foram aleatoriamente designadas para um dos três regimes: A - ropivacaína a 0,15% mais solução de sufentanil (0,2 µg/mL) como infusão peridural contínua (5 mL/h, imediatamente após o bolus inicial); B - ropivacaína a 0,1% mais sufentanil (0,2 µg/mL) como bolus epidural intermitente programado; C - solução idêntica à do Grupo A com bolus epidural intermitente programado. Os regimes BEIP foram programados como 10 mL por hora, começaram 60 minutos após o bolus inicial. Bolus de resgate de 5 mL da mesma solução foi administrado com bomba de infusão. A satisfação materna foi avaliada com uma escala numérica verbal de 0 a 10. Também avaliamos os resultados adversos maternais e neonatais. Resultados: Foram avaliadas 130 gestantes (A = 60, B = 33; C = 37). A mediana na escala numérica verbal para a satisfação materna foi de 8,8 no grupo A; 8,6 no grupo B e 8,6 no grupo C (p = 0,83). Encontramos uma taxa mais elevada para parto cesário no grupo A (56,7%; p = 0,02). Não observamos diferenças no bloqueio motor, taxa de parto instrumental e resultados neonatais. Conclusões: A manutenção da analgesia peridural com bolus epidural intermitente programado está associada a uma redução da incidência de parto cesariano com satisfação materna igualmente elevada e sem resultados adversos.