Effect of patient-controlled epidural analgesia with and without automatic intermittent bolus on levobupivacaine consumption during labour: A single centre prospective double-blinded randomised controlled study.

Abstract

BACKGROUND\nDuring labour, the effects of adding a programmed intermittent epidural bolus (PIEB) baseline analgesic regimen to patient-controlled epidural analgesia (PCEA) remain uncertain.\n\n\nMETHODS\nThis single centre prospective double-blinded controlled study randomised nulliparous women over 35 weeks of gestational age in a PCEA\u2009+\u2009PIEB or PCEA only group. After an epidural analgesia catheter was inserted a specific pump administered a solution of levobupivacaine 0.625\u2009mg.mL-1, sufentanil 0.25\u2009µg.mL-1, and clonidine 0.375\u2009µg.mL-1. In both groups the PCEA mode delivered an 8\u2009mL bolus with a lockout period of 8\u2009min. In the PCEA\u2009+\u2009PIEB group, women also received a programmed 8\u2009mL bolus every 60\u2009min. Additional bolus were allowed if required. The primary outcome was the hourly consumption of levobupivacaine from epidural catheter placement to new-born delivery. Secondary outcome were motor block, oxytocin use, sufentanil consumption, additional bolus required, instrumental vaginal delivery, unplanned caesarean section, pain during labour and women s satisfaction.\n\n\nRESULTS\nAnalysis included 162 and 155 women in the PCEA and PCEA\u2009+\u2009PIEB groups, respectively. The median [IQR] hourly consumption of levobupivacaine was significantly lower in the PCEA group (9.9 (7.8 - 12.4] mg.h-1) as compared to the PCEA\u2009+\u2009PIEB group (11.2 [7.9 - 14.3] mg.h-1; p = 0.046). The difference between medians was 1.3\u2009mg.h-1 95% CI (0.1 - 2.9). There was no difference between groups for secondary outcomes.\n\n\nCONCLUSIONS\nPCEA only modestly decreased the hourly consumption of local anaesthetic as compared to PCEA\u2009+\u2009PIEB but the difference was not clinically relevant.