Programmed intermittent epidural bolus in comparison with continuous
epidural infusion for uterine contraction pain relief after caesarean
section: a randomised, double-blind clinical trial
Abstract
Objective Programmed intermittent epidural bolus (PIEB) was reported to
provide superior maintenance of labour analgesia with better pain
relief, and less motor block than continuous epidural infusion (CEI).
Whether this is also evident for uterine contraction pain relief after
caesarean section remains unknown. Design Randomised, double blind,
positive-control trial. Setting Guangzhou Women and Children’s Medical
Center, China Population Parturients scheduled for elective caesarean
section under combined spinal-epidural anaesthesia were enrolled.
Methods At the end of the surgery, after a similar epidural loading dose
given, patients received either PIEB (6 mL every hour) or CEI (6 mL/h)
of 0.1% ropivacaine. Main outcome measures The primary outcome was the
effectiveness of uterine contraction pain relief during breastfeeding
assessed with visual analog scale score (VAS-UD) at the postoperative 36
h. Secondary main outcome was lower extremity motor block (defined as
Bromage score > 0). Results One hundred and twenty
parturients were studied (PIEB, 60; CEI, 60). The VAS-UD at the
postoperative 36 h was significantly lower in the PIEB group than in the
CEI group [median (IQR), 30 (20 to 40) mm] compared with the CEI
group [40 (30 to 50) mm], with an estimated difference of -10 mm
(95% CI -15 to -5 mm; P=0.001). Motor block was higher in the CEI group
than in the PIEB group during the study period except 2 h (all
P<0.05). Conclusions PIEB provides more effective uterine
contraction pain relief and less motor block after caesarean section
than CEI.