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. 2023 May 8;11(9):1350.
doi: 10.3390/healthcare11091350.

Combined Programmed Intermittent Bolus and Patient-Controlled Bolus Is a More Favorable Setting for Epidural Pain Relief Than Continuous Infusion

Shih-Kai Liu  1 , Shao-Chun Wu  2 , Shao-Chi Hung  1 , Kuen-Bao Chen  1 , Amina M Illias  3 , Yung-Fong Tsai  3
Affiliations

Combined Programmed Intermittent Bolus and Patient-Controlled Bolus Is a More Favorable Setting for Epidural Pain Relief Than Continuous Infusion

Shih-Kai Liu et al. Healthcare (Basel). .

Abstract

Epidural analgesia is a suitable and effective treatment for labor pain. However, the preferable modality setting for delivery remains debatable. This study adopted a programmed intermittent epidural bolus (PIEB) setting in conjunction with a patient-controlled epidural analgesia (PCEA) setting to improve the quality of labor analgesia and reduce the number of medical staff. We conducted a prospective observational analysis of primigravida parturients scheduled for spontaneous labor, which required epidural analgesia for painless labor. A total of 483 healthy primigravida parturients with singleton pregnancies were included in this cohort; 135 nulliparous patients were assigned to the continuous infusion setting (CEI) group and 348 to the PIEB + PCEA group. Compared to the CEI setting, the PIEB + PCEA setting significantly reduced the manual rescue by the clinician, extended the time required for the first manual rescue dose, and acclaimed good maternal satisfaction. The use of the CEI mode increased for poor performance requiring more than two rescues with an odds ratio of 2.635 by a binary logistic regression analysis. Using the PIEB + PCEA setting as the maintenance infusion had a longer duration for the first requested manual rescue, fewer manual rescue boluses, excellent satisfaction, and no significant increase in adverse events compared to the CEI setting.

Keywords: continuous epidural infusion; epidural analgesia; maternal satisfaction; patient-controlled epidural analgesia; programmed intermittent bolus.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the study participants. CEI, continuous epidural infusion; PIEB, programmed intermittent epidural boluses; PCEA, patient-controlled epidural analgesia.
Figure 2
Figure 2
Cumulative percentage of primipara without rescue dose between the CEI and PIEB + PCEA groups. The overall primipara percentage without rescue was compared between the CEI and PIEB + PCEA groups. CEI, continuous epidural infusion; PIEB, programmed intermittent epidural boluses; PCEA, patient-controlled epidural analgesia.
See this image and copyright information in PMC

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