High-volume patient-controlled epidural vs. programmed intermittent epidural bolus for labour analgesia: a randomised...

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Pain Management

Background:

• Neuraxial analgesia aims for effective pain relief with minimal adverse effects.
• Programmed intermittent epidural bolus (PIEB) is a newer technique for epidural analgesia maintenance.
• Previous studies had limitations in comparing bolus volumes between PIEB and patient-controlled epidural analgesia (PCEA).

Purpose of the Study:

• To compare the efficacy and safety of PCEA versus PIEB for labor analgesia using equal bolus volumes.
• To determine non-inferiority of PCEA regarding breakthrough pain.
• To assess superiority of PCEA in local anesthetic consumption.

Main Methods:

• A randomized, multicenter, non-inferiority trial involving 360 nulliparous women.
• Participants were allocated to either PCEA-only or PIEB groups, both using 10ml boluses.
• Primary outcomes included breakthrough pain incidence and total analgesic intake; secondary outcomes covered motor block, pain scores, satisfaction, and maternal/neonatal outcomes.

Main Results:

• Breakthrough pain was similar between groups (11.2% PCEA vs. 10.8% PIEB), meeting non-inferiority criteria.
• Total ropivacaine consumption was significantly lower in the PCEA group (mean difference 15.3 mg, p < 0.001).
• Motor block, patient satisfaction, and maternal/neonatal outcomes were comparable across both groups.

Conclusions:

• Patient-controlled epidural analgesia (PCEA) is non-inferior to programmed intermittent epidural bolus (PIEB) for labor analgesia when equal volumes are administered.
• PCEA demonstrates superiority in reducing local anesthetic consumption compared to PIEB.
• Both techniques provide comparable pain relief and safety profiles for laboring women.