Background: Continuous epidural infusion (CEI) has been an optimal and acceptable technique for inducing epidural anesthesia. This study compared two methods of programmed intermittent epidural bolus (PIEB) with CEI in labor analgesia among patients receiving epidural dexmedetomidine.
Methods: This study was a randomized clinical trial. The target population was term women candidates for epidural anesthesia. After selection of sample size based on inclusion criteria, a total of 3 cc of dexmedetomidine (0.5 µg/ml) and Ropivacaine 0.1% was injected. Furthermore, 5 ml was injected as a loading dose of dexmedetomidine 0.5 µg /ml and Ropivacaine 0.1%. Then the pain score was recorded. SPSS software Version 23 was used for statistical analysis of data.
Results: The neonatal Apgar score in PIEB method was more improved (P = 0.003) and the use of assisted delivery tools such as vacuum, in PIEB method was reduced. (p=0.038) Duration of the first phase of the labor in this method was more reduced than CEI.(p=0.015) Patients in the group undergoing epidural anesthesia by PIEB method were associated with a higher level of satisfaction with the delivery process (p < 0.05) than patients undergoing CEI protocol.
Conclusion: PIEB method is associated with further improvement in neonatal Apgar score and maternal outcomes (reduction in the duration of the first phase of labor and no need to use assisted delivery methods) compared to the CEI protocol, but has little effect on hemodynamic conditions or drug dosage.
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http://dx.doi.org/10.22088/cjim.14.4.648 | DOI Listing |
Best Pract Res Clin Anaesthesiol
September 2024
Department of Anaesthesiology, GZA Hospitals, Antwerp, Belgium.
Labour analgesia is a crucial aspect of obstetric anaesthesia, aiming to alleviate pain during childbirth while ensuring maternal and foetal safety. Over the past decade, advancements in labour analgesia techniques have evolved, impacting initiation, maintenance, and outcomes. We emphasize the longstanding importance of epidural analgesia while recognizing the growing significance of combined spinal-epidural and dural puncture epidural techniques for labour initiation.
View Article and Find Full Text PDFDrug Des Devel Ther
December 2024
Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing City, People's Republic of China.
Background: Interval time, defined as the period of time that effective analgesia can be achieved without the need for patient-controlled epidural analgesia (PCEA), has been investigated as an important parameter for the design of programmed intermittent epidural bolus (PIEB) approaches to labor analgesia. PCEA approaches offer flexibility in the management of labor-related pain while minimizing the risk of patient overdose. Here, the optimal interval between PIEB boluses of 0.
View Article and Find Full Text PDFMedicine (Baltimore)
November 2024
Department of Anesthesiology, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, Guangdong Province, China.
Background: Labor analgesia can be achieved by different approaches. The efficacy and safety of combined dural puncture epidural (DPE) with program intermittent epidural bolus (PIEB) are not well characterized. This study aimed to compare the efficacy and safety of DPE combined with PIEB vs epidural (EP) combined with PIEB for labor analgesia.
View Article and Find Full Text PDFDrug Des Devel Ther
November 2024
Department of Anesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People's Republic of China.
Can J Anaesth
October 2024
Department of Anesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
Purpose: To determine the optimal programmed intermittent epidural bolus (PIEB) volume for providing effective analgesia in 90% of patients (EV) during the first stage of labour using the dural puncture epidural (DPE) technique to initiate labour analgesia.
Methods: We conducted a biased-coin up-and-down sequential allocation study. We included 40 nulliparous women requiring epidural labour analgesia.
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