Comparision of Intermittent Bolus versus Continuous Infusion of Epidural Labour Analgesia by 0.15% Ropivacaine and Fentanyl: A Randomised Clinical Study
Introduction: Epidural labour analgesia is considered to be the most effective method to produce pain relief during labour. Programmed Intermittent Epidural Bolus (PIEB) has been observed to have many advantages over Continuous Epidural Infusion (CEI) like reduced incidence of breakthrough pain,...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2021-11-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/15634/51985_CE[Ra1]_CE[Ra1]_F(SHU)_PF1(SC_SS)_PFA(SC_KM)_PN(KM).pdf |
| Summary: | Introduction: Epidural labour analgesia is considered to be
the most effective method to produce pain relief during labour.
Programmed Intermittent Epidural Bolus (PIEB) has been
observed to have many advantages over Continuous Epidural
Infusion (CEI) like reduced incidence of breakthrough pain, local
anaesthetic usage, instrumental delivery, shorter second stage
of labour and more maternal satisfaction. Administration of local
anaesthetic solution as PIEB at regular intervals has shown to
spread more extensively in the epidural space compared to CEI,
possibly enabling greater efficacy.
Aim: To compare the intermittent bolus versus continuous
infusion of epidural labour analgesia with the primary objective
to measure the total local anaesthetic consumption of 0.15%
ropivacaine and fentanyl.
Materials and Methods: The randomised double blind study
was carried out on parturient in Obstetrics and Gynaecology
Department at Fortis Hospital, Bengaluru, Karnataka, India
from June 2014 to June 2015. The present study compared
60 primiparous females (divided into two groups of 30 each).
Labour analgesia was provided by bolus of 12 mL of 0.15%
ropivacaine and 2 µg/mL fentanyl, after one hour of the initial
bolus dose, group I parturients received 8 mL of 0.15%
ropivacaine with fentanyl 2 µg/mL hourly and group C parturients
received same solution as continuous infusion immediately. If
patient complained of pain or Visual Analog Scale (VAS) score
≥4, additional 8 mL of the same solution was given. Total dose
of 0.15% ropivacaine, number of rescue doses, pain scores,
motor block and second stage of labour were compared.
Results: The mean age in group I was 27.93±1.14 and in group C
was 27.87±1.28 years. Total dose of ropivacaine in group I
was 41.45±14.62 mg and in group C was 59.20±21.12 mg
(p-value=0.0004). In group C, at 2nd hour, VAS score (3.03±1.88)
was more compared to intermittent bolus group (1.40±2.02),
which was statistically significant (p-value=0.002). No motor
block was observed in group I, but two parturients in group C
had modified Bromage score of 4. Second stage of labour
was significantly reduced in group I compared to group C
(p-value <0.001). Less instrumental delivery and more maternal
satisfaction was observed in group I.
Conclusion: Intermittent bolus group required less rescue doses
hence, less total local anaesthetic dose with better analgesic
efficacy. |
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| ISSN: | 2249-782X 0973-709X |