Anesthesia & Clinical Research
Open Access

Abstract

Comparison of Intermittent Epidural Bolus vs. Continuous Epidural Infusion in Labor Analgesia

Ruchika Choudhary, Kalpana Verma, Sakshi Kadian, Durga Jethava and Dharam Das Jethava

Introduction: Intermittent epidural boluses during labor produce more uniform block and require reduced dose of local anesthetic as compared to continuous infusion but there are limited studies to assess the effect of intermittent epidural boluses on maternal motor activity, labor and neonatal outcomes.
Methods: A prospective randomized double blind comparative study was done on 100 patients (50 per group). Labor analgesia was provided by programmed intermittent epidural boluses (PIEB) with bolus of injection. Levobupivacaine 0.0625%, 20 ml+1mcg/ ml fentanyl followed by bolus 10 ml of 0.0625% levobupivacaine +1microgram/ml fentanyl every hour beginning 60 minutes after initial loading dose and continuous epidural infusion (CEI) in which bolus of 20 of 20 ml levobupivacaine 0.0625%+fentanyl 1 mcg/ml was given followed by 10 ml/hour infusion of levobupivacaine 0.0625% with fentanyl 1 mcg/ml beginning immediately after the loading dose. We compared the duration of second stage of labor, total dose of anesthetic used, mode of delivery, neonatal outcome.
Results: The total amount of levobupivaciane and fentanyl consumed (ml) was 34.33 ± 12.75 and 48.05 ± 16.83 respectively in PIEB and 39.38 ± 9.39 (p=0.04) and 48.05 ± 16.83 (p<0.001) respectively in CEI group. The PIEB group patients had shorter second stage of labor 39.32 ± 13.73 minutes in PIEB group while 45.68 ± 13.60 minutes in CEI group (p=0.022). The number of additional rescue boluses was 4 in PIEB and 17 in CEI (p=0.011).
Conclusions: PIEB is better as compared to CEI in terms of decreased dose of local anesthetic and opioid, lesser number of recue analgesic bolus requirement and shorter second stage of labor.