- L Gabriel, J Young, I Hoesli, T Girard, and S Dell-Kuster.
- University of Basel, Basel, Switzerland.
- Br J Anaesth. 2019 Aug 1; 123 (2): e434-e441.
BackgroundSeveral randomised controlled trials show that maintenance of labour epidural analgesia with programmed intermittent epidural bolus reduces the maternal motor block compared with maintenance with a continuous infusion. However, these trials were usually restricted to healthy nulliparous parturients. To assess the generalisability of these randomised controlled trials to 'real-world' conditions, we compared maternal motor function (modified Bromage score) over time between healthy nulliparous and parous women using routinely collected quality-control data.MethodsAfter ethical approval, all parturients receiving programmed intermittent epidural bolus labour analgesia between June 2013 and October 2014 were included in this prospective cohort study. Bupivacaine 0.1% with fentanyl 2 μg ml-1 was used allowing for patient-controlled bolus every 20 min. The maternal motor function (primary outcome) was regularly assessed from insertion of the epidural catheter until delivery.ResultsOf the 839 parturients included, 553 (66%) were nulliparous and 286 (34%) were parous. The parous women had a shorter median duration of epidural analgesia (3 h 59 min vs 5 h 45 min) and a higher incidence of spontaneous delivery (66% vs 37%). The probability of being in a certain Bromage category at birth was similar in nulliparous and parous women in a general additive model adjusting for duration of epidural analgesia, number of rescue top-ups, and number of catheter manipulations (cumulative odds ratio: 1.18; 95% confidence interval: 0.98-1.41). Parous women required a higher time-weighted number and volume of rescue top-ups.ConclusionsThe results of the randomised controlled trials on a reduced motor block with programmed intermittent epidural bolus seem generalisable to parturients typically not included in these trials.Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
This article appears in the collection: Programmed Intermittent Epidural Bolus for Labour Analgesia.
Do you have a pearl, summary or comment to save or share?
You can also include formatting, links, images and footnotes in your notes
- Simple formatting can be added to notes, such as
- Superscript can be denoted by
- Numbered or bulleted lists can be created using either numbered lines
1. 2. 3., hyphens
- 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..