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Epidural Analgesia for Labor: Continuous Infusion Versus Programmed Intermittent Bolus
1Department of Anesthesiology and Critical Care, Perelman School of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104, USA.
Anesthesiology Clinics
|January 30, 2017
Summary
Programmed intermittent epidural bolus may offer superior labor analgesia compared to traditional methods. This technique potentially improves anesthetic distribution in the epidural space, especially during prolonged labor, warranting further research.
Area of Science:
- Anesthesiology
- Obstetrics
- Pain Management
Background:
- Traditional labor analgesia often combines continuous epidural infusion with patient-controlled epidural analgesia (PCEA) via automated pumps.
- Concerns exist regarding the efficacy and distribution of anesthetic solutions with current standard epidural techniques.
Purpose of the Study:
- To evaluate the programmed intermittent epidural bolus (PIEB) technique as a superior maintenance mode for labor analgesia.
- To explore the potential of PIEB for improved anesthetic distribution in the epidural space.
Main Methods:
- Review and analysis of compelling data comparing PIEB with traditional epidural methods.
- Focus on anesthetic solution distribution within the epidural space.
- Consideration of prolonged labor scenarios.
Main Results:
- Bolus injection via epidural catheter shows potential for enhanced anesthetic distribution.
- PIEB is proposed as a more effective maintenance mode for labor analgesia.
- The technique may be particularly beneficial in prolonged labor.
Conclusions:
- Programmed intermittent epidural bolus represents a promising advancement in labor analgesia.
- Further prospective, adequately powered studies are required.
- Optimal PIEB parameters (volume, rate, time, concentration) need determination.
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