Programmed intermittent epidural boluses (pieb) for labor analgesia: study of the sensor block and effects on maternal motor function

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Abstract

Background. Programmed intermittent epidural boluses (PIEB) technique is a promising approach that demonstrates certain advantages over traditional techniques of epidural analgesia. We compared the dynamics of the sensory block of PIEB + parturient-controlled epidural analgesia (PCEA) with continuous epidural infusion (CEI) + PCEA for maintenance labor analgesia and the incidence of motor block (MB) in women who received PIEB or traditional techniques.

Methods. A total of 165 subjects were studied. All parturients were divided into five groups: manual boluses, PCEA, PCEA + CEI, PIEB + PCEA; levobupivacaine 0.25 mg/mL; 1.25 mg/mL; 0.625 mg/mL. The level of the MB was evaluated by the classic Bromage scale (0-1-2-3). The level of the sensor block was evaluated by the pin-prick test.

Results. MB was reported in 80% in group 1 120 min after analgesia, 78% and 52% in groups 2 and 3 at the 150th min (p < 0.001); in group 4, the MB frequency was 6% 15 min after the start and was increasing to 40% at full cervical dilation (p < 0.001). In group 5, the relative MB frequency did not exceed 10% at the 120th min and was 0% at full cervical dilation (p < 0.00001). The results indicate that in the PIEB group, the level of sensory block in patients was higher 15 min after the start of analgesia and remained so until the end of the observation period [median PIEB Th5 versus Th8 in the CEI group, (p < 0.0004)].

Conclusions. PIEB + PCEA technique maintained a consistently high level of sensor block throughout the study compared to PCEA + CEI, which ensured effective analgesia in the first and second stages of labor with minimal MB.

About the authors

Ekaterina Y. Upryamova

Moscow Regional Research Institute of Obstetrics and Gynecology

Author for correspondence.
Email: katerinaupryamova@gmail.com
ORCID iD: 0000-0002-7057-2149

MD, PhD, Head of Anesthesiology and Critical Care Department

Russian Federation, 101000, Moscow,

E. M. Shifman

M.F. Vladimirsky Moscow regional Research and Clinical Institute

Email: katerinaupryamova@gmail.com
ORCID iD: 0000-0002-6113-8498
Russian Federation, 129110, Moscow

V. I. Krasnopolskij

Moscow Regional Research Institute of Obstetrics and Gynecology

Email: katerinaupryamova@gmail.com
Russian Federation, 101000, Moscow

A. M. Ovezov

M.F. Vladimirsky Moscow regional Research and Clinical Institute

Email: katerinaupryamova@gmail.com
ORCID iD: 0000-0001-7629-6280
Russian Federation, 129110, Moscow

References

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Supplementary files

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2. Fig. 1. Block diagram of study participants (EA – epidural analgesia; Bolus EA – bolus epidural analgesia; PCEA – patient-controlled epidural analgesia; PCEA + CEI – patient-controlled epidural analgesia + continuous epidural analgesia; PIEB + PCEA – programmed intermittent epidural bolus + patient-controlled epidural analgesia; Levo – levobupivacaine)

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3. Fig. 2. Dynamics of the relative frequency of the motor block in groups 1–5 during the observation period and at the second stage

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4. Fig. 3. Comparison of the dynamics of the relative frequency of the motor block between groups 4 and 5 during the observation period and at the second stage

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5. Fig. 4. Comparison of the dynamics of the mean values of the sensor block level between the CEI and PIEB groups for the all observation period

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6. Fig. 5. Comparison of the dynamics of the sensor block level between the CEI and PIEB groups for the all observation period

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7. Fig. 6. Comparison of sensor block levels at the second stage between the CEI and PIEB groups

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