Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr;26(1):25-30.
doi: 10.2478/rjaic-2019-0004.

A randomized comparison of low dose ropivacaine programmed intermittent epidural bolus with continuous epidural infusion for labour analgesia

Oksana V Riazanova  1 , Yuri S Alexandrovich  1 , Yana V Guseva  1 , Alexander M Ioscovich  2
Affiliations

A randomized comparison of low dose ropivacaine programmed intermittent epidural bolus with continuous epidural infusion for labour analgesia

Oksana V Riazanova et al. Rom J Anaesth Intensive Care. 2019 Apr.

Abstract

Background: Two methods of local anaesthetic administration into the epidural space in natural delivery pain management are compared in the article. Methods compared are programmed intermittent epidural bolus (PIEB) and continuous epidural infusion (CEI). Patient-controlled epidural analgesia was provided simultaneously in all cases.

Methods: 84 primipara with average age 30.7 (27.5-34) years, and gestational age 39.1 (38.5-40) weeks planned to natural delivery were examined. PIEB and patient controlled epidural analgesia was used in the first group. Patient controlled epidural analgesia and continuous epidural infusion (CEI) of local anaesthetic was used in the second group. Ropivacaine hydrochloride 0.08% without any adjuvants was utilized as local anaesthetic. Pain assessment was conducted using VAS while motor block was assessed using the Bromage scale.

Results: Labor progression dynamics and condition of newborns were equally independent to the method of analgesia. However, analgesic endpoint was better and more long-lasting while using PIEB with patient controlled epidural analgesia. Moreover, a lesser amount of local anaesthetic was consumed. In the group with programmed bolus, the total volume of local anaesthetic was 59.9 (45-66) ml in comparison with 69.5 (44-92) ml in the continuous infusion group (p = 0.033). The time to first bolus requested by the puerpera was significantly longer in the programmed bolus group - 89.2 (57-108) min compared to 43.2 (35-65) minutes in the continuous infusion group (p = 0.021).

Conclusion: Administration of low-concentrated ropivacaine solution 0.08% with no opioids using PIEB provides better and more prolonged analgesia with less local anaesthetic consumption and without any additional maternal and newborn side effects in comparison with continuous infusion.

Keywords: Bromage scale; continuous infusion; delivery; patient controlled epidural analgesia; programmed intermittent epidural bolus.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest Nothing to declare

References

    1. Aleksandrovich YS, Murieva EA, Pshenisnov KV, Riazanova OV. Hormonal status of the mother and her newborn child after using long-term epidural analgesia in childbirth. Pediatrician. 2011;2:51–55.
    1. Ding T, Wang DX, Qu Y, Chen Q, Zhu SN. Epidural labor analgesia is associated with a decreased risk of postpartum depression: a prospective cohort study. Anesth Analg. 2014;119:383–392. doi: 10.1213/ANE.0000000000000107. - DOI - PubMed
    1. Suhitharan T, Pham TP, Chen H, Assam PN, Sultana R, Han NL, et al. Investigating analgesic and psychological factors associated with risk of postpartum depression development: a case-control study. Neuropsychiatr Dis Treat. 2016;12:1333–1339. doi: 10.2147/NDT.S105918. - DOI - PMC - PubMed
    1. Riazanova OV, Aleksandrovich YS, Reznik VA, Gorkovaya IA, Korgozha MA, Ioskovich A. Labor pain relief and postpartum depression. Is there a correlation? Journal of Obstetrics and Women’s Diseases. 2017;66:11–19. doi: 10.17816/JOWD66511-20. - DOI
    1. Sng BL, Zeng Y, de Souza NNA, Leong WL, Oh TT, Siddiqui FJ, et al. Automated mandatory bolus versus basal infusion for maintenance of epidural analgesia in labour. Cochrane Database Syst Rev. 2018;5:CD011344. doi: 10.1002/14651858.CD011344.pub2. - DOI - PMC - PubMed

LinkOut - more resources