• Anesthesiology · Apr 2018

    Randomized Controlled Trial

    Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia: A Randomized Clinical Trial.

    • Lange Elizabeth M S EMS From the Department of Anesthesiology (E.M.S.L., P.C.F., W.F.D., S.R., R.J.M., P.T.) and the Center for Healthcare Studies (P.T.), Northwestern Un, Cynthia A Wong, Paul C Fitzgerald, Wilmer F Davila, Suman Rao, Robert J McCarthy, and Paloma Toledo.
    • From the Department of Anesthesiology (E.M.S.L., P.C.F., W.F.D., S.R., R.J.M., P.T.) and the Center for Healthcare Studies (P.T.), Northwestern University Feinberg School of Medicine, Chicago, Illinois; and the Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa (C.A.W.).
    • Anesthesiology. 2018 Apr 1; 128 (4): 745-753.

    BackgroundProgrammed intermittent boluses of local anesthetic have been shown to be superior to continuous infusions for maintenance of labor analgesia. High-rate epidural boluses increase delivery pressure at the catheter orifice and may improve drug distribution in the epidural space. We hypothesized that high-rate drug delivery would improve labor analgesia and reduce the requirement for provider-administered supplemental boluses for breakthrough pain.MethodsNulliparous women with a singleton pregnancy at a cervical dilation of less than or equal to 5 cm at request for neuraxial analgesia were eligible for this superiority-design, double-blind, randomized controlled trial. Neuraxial analgesia was initiated with intrathecal fentanyl 25 μg. The maintenance epidural solution was bupivacaine 0.625 mg/ml with fentanyl 1.95 μg/ml. Programmed (every 60 min) intermittent boluses (10 ml) and patient controlled bolus (5 ml bolus, lockout interval: 10 min) were administered at a rate of 100 ml/h (low-rate) or 300 ml/h (high-rate). The primary outcome was percentage of patients requiring provider-administered supplemental bolus analgesia.ResultsOne hundred eight women were randomized to the low- and 102 to the high-rate group. Provider-administered supplemental bolus doses were requested by 44 of 108 (40.7%) in the low- and 37 of 102 (36.3%) in the high-rate group (difference -4.4%; 95% CI of the difference, -18.5 to 9.1%; P = 0.67). Patient requested/delivered epidural bolus ratio and the hourly bupivacaine consumption were not different between groups. No subject had an adverse event.ConclusionsLabor analgesia quality, assessed by need for provider- and patient-administered supplemental analgesia and hourly bupivacaine consumption was not improved by high-rate epidural bolus administration.

      Pubmed     Full text   Copy Citation  

      Add institutional full text...

    This article appears in the collection: Programmed Intermittent Epidural Bolus for Labour Analgesia.

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

Want more great medical articles?

Keep up to date with a free trial of metajournal, personalized for your practice.
988,657 articles already indexed!

We guarantee your privacy. Your email address will not be shared.