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Meta-Analysis
. 2022 Feb 4;101(5):e28742.
doi: 10.1097/MD.0000000000028742.

Programmed intermittent epidural bolus in parturients: A meta-analysis of randomized controlled trials

Xian-Xue Wang  1 , Xiao-Lan Zhang  2 , Zhao-Xia Zhang  2 , Zi-Qin Xin  2 , Hua-Jing Guo  1 , Hai-Yan Liu  2 , Jing Xiao  2 , Yun-Lin Zhang  2 , Shu-Zhen Yuan  2
Affiliations
Meta-Analysis

Programmed intermittent epidural bolus in parturients: A meta-analysis of randomized controlled trials

Xian-Xue Wang et al. Medicine (Baltimore). .

Abstract

Background: To evaluate the efficacy and safety of programmed intermittent epidural bolus (PIEB) in parturients.

Methods: The PubMed, Embase, and the Cochrane Library (from inception to July 2021) were searched for identification of randomized placebo-controlled trials in which PIEB was applied in parturients. The outcomes were the effect of analgesia, satisfaction score, mode of delivery, duration of labor, neonatal condition, and adverse events. The pooled odds ratios (OR), weighted mean difference (WMD), and 95% confidence intervals (CIs) were calculated using random- and fixed-effects models.

Results: PIEB was found to be associated with decreased total consumption of ropivacaine (WMD = -15.83, 95% CI: -19.06 to -12.60, P < .00001; I2 = 61%; P for heterogeneity = .04), total consumption of sufentanil (WMD = -4.93, 95% CI: -6.87 to 2.98, P < .00001; I2 = 68%; P for heterogeneity = .05), numbers of patients who require patient-controlled epidural analgesia bolus (OR = 0.27, 95% CI: 0.14-0.51, P < .0001; I2 = 65%; P for heterogeneity = .01), the number of attempts (WMD = -4.12, 95% CI: -7.21 to -1.04, P = .009; I2 = 100%; P for heterogeneity < .00001), rate of breakthrough pain (OR = 0.47, 95% CI: 0.28-0.80, P = .005; I2 = 47%; P for heterogeneity = .09). Eight studies focus on the duration of analgesia. After by meta-analysis, we found that the pain visual analogue scale (VAS) score at 30 minutes, 2 hours, 4 hours, and 5 hours in PIEB group was significantly lower when compared with control group, (WMD = -0.15, 95% CI: -0.26 to -0.04, P = .006; I2 = 0%; P for heterogeneity = .64), (WMD = -0.79, 95% CI: -1.32 to 0.25, P = .004; I2 = 97%; P for heterogeneity < .00001), (WMD = -1.00, 95% CI: -1.08 to -0.91, P < .00001; I2 = 0%; P for heterogeneity = .67), (WMD = -1.81, 95% CI: -3.23 to -0.39, P = .01; I2 = 98%; P for heterogeneity < .00001), respectively. Nineteen studies discussed the mode of delivery between 2 groups. The results suggest that the rate of normal delivery is significantly higher in PIEB group compared with control group (OR = 1.37, 95% CI: 1.08-1.75, P = .01). The time of first and second stage of labor are significantly shorter in PIEB group compared with control group, the result is (WMD = -10.52, 95% CI: -14.74 to 4.76, P < .00001; I2 = 0%; P for heterogeneity = .86), (WMD = -1.48, 95% CI: -2.26 to -0.69, P = .0002; I2 = 35%; P for heterogeneity = .10), respectively. Thirteen studies concerned the satisfaction score of patients. The satisfaction score of patients in the PIEB group was significantly higher when compared with control group (WMD = 0.91, 95% CI: 0.42-1.39, P = .0003; I2 = 98%; P for heterogeneity < .00001). The Apgar score at 1, 5 minutes in PIEB group are significantly higher (WMD = 0.07, 95% CI: 0.02-0.13 P = .007; I2 = 55%; P for heterogeneity = .04), (WMD = -0.08, 95% CI: -0.12 to -0.05, P < .00001; I2 = 21%; P for heterogeneity = .27), respectively.

Conclusions: PIEB is a good alternative for labor analgesia with better analgesic effect, maternal and infant outcome.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of the search strategy and study selection.
Figure 2
Figure 2
A. Graph of review authors’ assessments of risk of bias for each Cochrane item. B. Summary of review authors’ assessments of risk of bias for each Cochrane item and each included study.
Figure 3
Figure 3
Meta-analysis of the net change in total consumption of ropivacaine. CI = confidence interval, PIEB = programmed intermittent epidural bolus, SD = standard deviation.
Figure 4
Figure 4
Meta-analysis of the net change in total consumption of sufentanil. CI = confidence interval, PIEB = programmed intermittent epidural bolus, SD = standard deviation.
Figure 5
Figure 5
Meta-analysis of the net change in rate of patients who need additional PCEA bolus. CI = confidence interval, PIEB = programmed intermittent epidural bolus.
Figure 6
Figure 6
Meta-analysis of the net change on the number of attempts. CI = confidence interval, PIEB = programmed intermittent epidural bolus, SD = standard deviation.
Figure 7
Figure 7
Meta-analysis of the net change on the rate of breakthrough pain. CI = confidence interval, PIEB = programmed intermittent epidural bolus.
Figure 8
Figure 8
Meta-analysis of the net change on the duration of analgesia. CI = confidence interval, PIEB = programmed intermittent epidural bolus, SD = standard deviation.
Figure 9
Figure 9
Meta-analysis of the net change on the pain VAS score at various time points. CI = confidence interval, PIEB = programmed intermittent epidural bolus, SD = standard deviation.
Figure 10
Figure 10
Meta-analysis of the net change in rate of mode of delivery. CI = confidence interval, PIEB = programmed intermittent epidural bolus.
Figure 11
Figure 11
Meta-analysis of the net change in time of labor. CI = confidence interval, PIEB = programmed intermittent epidural bolus, SD = standard deviation.
Figure 12
Figure 12
Meta-analysis of the net change on the satisfaction score. CI = confidence interval, PIEB = programmed intermittent epidural bolus, SD = standard deviation.
Figure 13
Figure 13
Meta-analysis of the net change on the rate of bradycardia. CI = confidence interval, PIEB = programmed intermittent epidural bolus.
Figure 14
Figure 14
Meta-analysis of the net change on the fetal heart rate. CI = confidence interval, PIEB = programmed intermittent epidural bolus, SD = standard deviation.
Figure 15
Figure 15
Meta-analysis of the net change on the Apgar score at 1, 5 minutes. CI = confidence interval, PIEB = programmed intermittent epidural bolus, SD = standard deviation.
Figure 16
Figure 16
Meta-analysis of the net change in rate of pruritus. CI = confidence interval, PIEB = programmed intermittent epidural bolus.
Figure 17
Figure 17
Meta-analysis of the net change in rate of hypotension. CI = confidence interval, PIEB = programmed intermittent epidural bolus.
Figure 18
Figure 18
Meta-analysis of the net change in rate of shivering. CI = confidence interval, PIEB = programmed intermittent epidural bolus.
Figure 19
Figure 19
Meta-analysis of the net change in rate of nausea. CI = confidence interval, PIEB = programmed intermittent epidural bolus.
Figure 20
Figure 20
Meta-analysis of the net change in rate of vomiting. CI = confidence interval, PIEB = programmed intermittent epidural bolus.
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