Related Experiment Video
Updated: Jul 30, 2025
14:56
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
21.4K
Combined Programmed Intermittent Bolus and Patient-Controlled Bolus Is a More Favorable Setting for Epidural Pain
Shih-Kai Liu1, Shao-Chun Wu2, Shao-Chi Hung1
1Department of Anesthesiology, China Medical University Hospital and China Medical University, Taichung 404327, Taiwan.
Healthcare (Basel, Switzerland)
|May 13, 2023
Summary
Programmed intermittent epidural bolus (PIEB) with patient-controlled epidural analgesia (PCEA) offers superior labor pain management compared to continuous infusion. This approach reduces the need for clinician intervention and enhances maternal satisfaction during childbirth.
Area of Science:
- Obstetrics and Gynecology
- Anesthesiology
- Pain Management
Background:
- Epidural analgesia is a standard for labor pain relief, but optimal delivery settings are debated.
- Continuous infusion epidural analgesia (CEI) is common, yet may require frequent adjustments.
- Programmed intermittent epidural bolus (PIEB) combined with patient-controlled epidural analgesia (PCEA) offers a potentially improved approach.
Purpose of the Study:
- To compare the efficacy and patient satisfaction of PIEB + PCEA versus CEI for labor analgesia.
- To assess the impact on clinician intervention and need for supplemental analgesia.
- To evaluate maternal satisfaction and adverse events associated with different epidural settings.
Main Methods:
- Prospective observational analysis of 483 healthy primigravida parturients undergoing spontaneous labor.
- Comparison between a group receiving continuous epidural infusion (CEI) (n=135) and a group receiving PIEB + PCEA (n=348).
- Data collected on clinician interventions, time to first rescue dose, maternal satisfaction, and adverse events.
Main Results:
- The PIEB + PCEA group experienced significantly fewer manual rescues by clinicians compared to the CEI group.
- The time to the first manual rescue dose was significantly longer in the PIEB + PCEA group.
- Maternal satisfaction was notably higher in the PIEB + PCEA group, with no significant increase in adverse events.
Conclusions:
- PIEB + PCEA is an effective labor analgesia strategy, improving patient satisfaction and reducing the need for clinician intervention.
- CEI use was associated with a higher likelihood of requiring multiple rescue doses.
- The PIEB + PCEA setting provides a safe and satisfactory alternative for labor pain management.
Related Concept Videos
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
463
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
463
01:29Drug Delivery: Parenteral Route
655
The parenteral route is a critical method of drug administration. It delivers compounds directly into the systemic circulation and bypasses the gastrointestinal tract. This approach is particularly advantageous for drugs that exhibit poor absorption or instability when administered orally.
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
655
01:24Parenteral Anesthetics: Overview
164
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
164
01:19One-Compartment Open Model for IV Bolus Administration: General Considerations
263
The one-compartment model is a pharmacokinetic tool that models the body as a single, uniform compartment, facilitating the understanding of drug distribution and elimination. This model is particularly beneficial for intravenous (IV) bolus administration, where the drug rapidly circulates throughout the body.
The drug's presence in the body is defined by an equation representing the difference between the rates of drug entry and exit. Key parameters—elimination rate constant,...
The drug's presence in the body is defined by an equation representing the difference between the rates of drug entry and exit. Key parameters—elimination rate constant,...
263
01:25Analgesia and Pain Management
684
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
684
01:18Two-Compartment Open Model: IV Bolus Administration
604
The two-compartment model for intravenous (IV) bolus administration illustrates drug distribution in the body, subdividing it into central and peripheral compartments. This model operates on the concept of two-compartment kinetics. The drug's plasma concentration shows a bi-exponential decline following IV bolus administration, signaling the presence of two disposition processes: distribution and elimination.
The disparity between drug input and the sum of drug transfer rates between...
The disparity between drug input and the sum of drug transfer rates between...
604