Journal article
Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia: A Randomized Clinical Trial
Anesthesiology (Philadelphia), Vol.128(4), pp.745-753
04/2018
DOI: 10.1097/ALN.0000000000002089
PMID: 29351097
Abstract
Programmed 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.
Nulliparous 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.
One 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.
Labor 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.
Details
- Title: Subtitle
- Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia: A Randomized Clinical Trial
- Creators
- Elizabeth M S Lange - 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.)Cynthia A WongPaul C FitzgeraldWilmer F DavilaSuman RaoRobert J McCarthyPaloma Toledo
- Resource Type
- Journal article
- Publication Details
- Anesthesiology (Philadelphia), Vol.128(4), pp.745-753
- Publisher
- United States
- DOI
- 10.1097/ALN.0000000000002089
- PMID
- 29351097
- ISSN
- 0003-3022
- eISSN
- 1528-1175
- Language
- English
- Date published
- 04/2018
- Academic Unit
- Anesthesia
- Record Identifier
- 9984007170002771
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