Labor Pain Clinical Trial
Official title:
Intermittent Bolus Administration of Ropivacaine for Epidural Labor Analgesia : an Observational Study
Enhanced patient safety and satisfaction have contributed to growing use of epidural labor
analgesia. Epidural analgesia appears to be currently the most effective technique in
reducing pain during labor. However, reduction in total dose of local anesthetic and thus
motor blockade is crucial to improve the obstetric outcome. This technique has evolved from
intermittent boluses by anesthesiologists to the current standard labor epidural analgesic
regimens in many institutions in North America and Europe that consist of a local anesthetic
in combination with an opioid delivered via continuous epidural infusion (CEI) with or
without patient-controlled epidural analgesia (PCEA) boluses. Recently,a new mode of
administration has been used: regular bolus of low concentration local anesthetic +
intermittent bolus (PIEB). This technique would offer safe and superior quality labor
analgesia and greater maternal satisfaction by reducing total amount of the drug combination.
The primary outcome was to evaluate the analgesic efficacy of PIEB epidural drug delivery in
terms of visual analogue scale satisfaction (VAS) score in a large cohort of patients. The
secondary outcomes were to measure the degree of motor blockade, neonatal and obstetric
outcomes, total drug dose and incidence of pain that required top-up administration
(breakthrough pain)
Patients were explained about the procedure and written informed consent was obtained.
Healthy term primi or second gravid parturients (aged >18 years) with a singleton, live fetus
in vertex presentation when in active stage of labor with cervical dilation of 3-5 cm were
recruited in the study after they requested epidural for pain relief. PIEB epidural analgesia
was used.
Primary outcome was maternal satisfaction during labor and delivery. Our hypothesis was that
patients would have a greater level of satisfaction when using PIEB technique. The secondary
outcomes were to measure the degree of motor blockade, neonatal and obstetric outcomes.
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