Programmed Intermittent Epidural Boluses (PIEB) for Maintenance of Labor Analgesia: A Superior Technique to Continuous Epidural Infusion?

Analgesic Effects of Epidural Labor Analgesia at Different Periods and Its Effects on Maternal and Infant Outcomes and MiRNA-146b Level

This paper aimed to analyze the analgesic effects of continuous epidural labor analgesia (ELA) at different periods and its effects on postpartum depression, maternal and infant outcomes, and maternal blood pressure. Giving birth in our hospital from September 2017 to August 2019, 119 primiparas with spontaneous delivery were enrolled and divided into an observation group (65 cases) and a control group (54 cases). Patients in the observation group received epidural block analgesia in advance, whereas those in the control group received epidural block analgesia routinely. At 25 days after delivery, breast milk samples were collected, in which miRNA-146b level was detected by PCR. The patients were compared between the two groups with respect to progress of labor, analgesic effects during 3 stages of labor, labor outcomes, adverse reactions, and levels of NO, ANP, and ET-1 in the parturients' umbilical artery blood. Compared with those in the control group, patients in the observation group had a remarkably higher miRNA-146b level in the breast milk (P < 0.05), remarkably lower average Visual Analogue Scale (VAS) scores during the active phase and the second stage of labor (P < 0.05), and remarkably higher levels of NO, ANP, and ET-1 (P < 0.05). There were no statistically significant differences in adverse reactions and modes of delivery between the two groups (P < 0.05). ELA starting from the latent phase can improve the miRNA-146b level in maternal breast milk, alleviate labor pain of parturients, and shorten stages of labor. Therefore, our study is worthy of clinical promotion. We still need to do more experiments and use more data to conclude more scientific results in future research work.

Effect of an evidence-based activity management program on delivery outcomes in pregnant women after intraspinal labor analgesia

OBJECTIVE

To investigate the effect of an evidence-based activity management program for pregnant women after intraspinal labor analgesia based on their delivery outcomes.

METHODS

A prospective study was conducted in 96 pregnant women who received intraspinal labor analgesia in our hospital. The control group (48 cases) received routine nursing care after analgesia, and the intervention group (48 cases) received evidence-based activity management program after analgesia. The labor time, sense of birth control, physiological and psychological stress reactions, analgesic effect, delivery outcome and early postpartum pelvic floor function were compared between the two groups.

RESULTS

Compared with the control group, the first, second and third stages of labor time and the total labor time of the intervention group were significantly shorter, while the Labor Agentry Scale (LAS) score was significantly higher (P<0.05). Compared with the control group, the diastolic blood pressure, systolic blood pressure, heart rate, Visual Analogue Scale (VAS) score, Self-Rating Anxiety Scale (SAS) score and Self-Rating Depression Scale (SDS) score of the intervention group were significantly lower (P<0.05). The total analgesic rate of the intervention group was significantly higher than that of the control group (95.83% vs. 79.17%, P<0.05). The overall incidence of postpartum hemorrhage, perineal laceration, lateral episiotomy, fetal distress and neonatal asphyxia in the intervention group was significantly lower than that of the control group (16.67% vs. 35.42%, P<0.05). The incidence of pelvic organ prolapse (POP) and pelvic floor dysfunction in the intervention group were significantly lower than those in the control group (P<0.05).

CONCLUSION

An evidence-based activity management program for pregnant women after intraspinal labor analgesia can effectively shorten the labor time, strengthen the analgesic effect, reduce the physiological and psychological stress reactions, increase the sense of control during birth and improve the delivery outcome as well as early pelvic floor function.

Labor outcomes with epidural analgesia: an observational before-and-after cohort study comparing continuous infusion versus programmed intermittent bolus plus patient-controlled analgesia

BACKGROUND

Scientific evidence shows that programmed intermittent epidural bolus (PIEB) for labor analgesia achieves good obstetric outcomes. After implementing our institutional standard for epidural analgesia, we compared PIEB + patient-controlled epidural analgesia (PCEA) versus continuous epidural infusion (CEI).

METHODS

In an observational cohort study, we compared CEI with 0.2% ropivacaine + 100-μg fentanyl initial bolus versus PIEB+PCEA with 0.1% ropivacaine + 2 μg mL^-1 fentanyl in primiparous women. The primary outcome was mode of delivery. Secondary outcomes were duration of the second stage of labor and total ropivacaine and fentanyl doses. Other outcomes, in the PIEB+PCEA group only, were motor block, use of PCEA and rescue bolus, maternal mobility and maternal satisfaction. Univariate statistical analysis was performed using the χ² Test, analysis of variance or nonparametric Kruskal-Wallis Test. Multivariate analysis was performed using multiple logistic regression analysis.

RESULTS

The study included 221 patients (CEI 116; PIEB+PCEA 105). Multiple logistic regression showed that the PIEB+PCEA group had significantly fewer caesarean sections (CEI [14%] vs. PIEB+PCEA [5%], P=0.015) and instrumental deliveries, after correcting for confounders (OR=0.49; 95% CI: 0.27-0.89). The second stage of labor did not significantly differ between groups. Total ropivacaine dose was significantly lower with PIEB+PCEA. There was no relationship between mild motor block and increased use of PCEA in the PIEB+PCEA group. Mode of delivery and duration of the second stage of labor were not influenced by motor block either. Maternal satisfaction was high.

CONCLUSIONS

PIEB+PCEA offers obstetric and analgesic advantages over CEI in daily clinical practice.

Programmed intermittent epidural bolus as compared to continuous epidural infusion for the maintenance of labor analgesia: a prospective randomized single-blinded controlled trial

Background

Programmed intermittent epidural bolus (PIEB) techniques are a new area of interest for maintaining labor analgesia due to the potential to decrease motor block and improve labor analgesia. This study compares continuous epidural infusion (CEI) to 2 PIEB regimens for labor analgesia.

Methods

One hundred fifty patients undergoing scheduled induction of labor at term gestation having epidural labor analgesia were randomized to receive an epidural analgesia regimen of bupivacaine 0.125% with fentanyl 2 μg/ml at either PIEB 5 ml every 30 min (Group 5q30), PIEB 10 ml every 60 min (Group 10q60), or 10 ml/h continuous infusion (Group continuous epidural infusion [CEI]). The primary outcome is the pain scores throughout labor. Secondary outcomes include degree of motor block, dermatomal sensory levels, the number of physician-administered boluses, and patient satisfaction.

Results

While the average pain scores throughout labor did not differ significantly between groups, fewer patients in group 10q60 received physician-administered boluses for breakthrough pain (34.9% in 10q60 vs. 61.0% in 5q30 and 61.9% in CEI, P = 0.022). Dermatomal sensory levels, degree of motor block, and patient satisfaction did not differ significantly between groups.

Conclusions

Our study suggests that high volume PIEB regimens for labor analgesia decrease breakthrough pain and physician-administered boluses.