Mapping the Effectiveness of Programmed Intermittent Epidural Bolus Versus Continuous Epidural Infusion for Labor...

Epidural analgesia is a cornerstone of labor pain management, utilizing continuous epidural infusion (CEI) or programmed intermittent epidural bolus (PIEB) to deliver local anesthetics combined with opioids. Hence, this scoping review maps the evidence on the comparative efficacy and outcomes of CEI versus PIEB in labor analgesia. A comprehensive search was conducted on PubMed, ScienceDirect, and Google Scholar databases for full-text English-language studies published between 2015 and March 2025. Inclusion criteria encompassed studies comparing CEI and PIEB in healthy term pregnant women, focusing on pain relief, motor block, maternal satisfaction, and obstetric outcomes. Overall, 11 studies were included, from which the results showed that PIEB consistently demonstrated superior pain relief, reduced motor block incidence, and higher maternal satisfaction. PIEB also required fewer anesthetics and fewer rescue boluses. Moreover, trends toward lower instrumental delivery rates and shorter second-stage labor duration were observed, although often statistically nonsignificant. Key research gaps include optimal dosing regimens, direct anesthetic comparisons, and long-term maternal and neonatal outcomes. In conclusion, PIEB appeared superior to CEI for labor analgesia, offering enhanced pain control, reduced motor block, and improved satisfaction. However, large, multicenter randomized controlled trials with standardized protocols and extended follow-up are needed to optimize PIEB and confirm its benefits across diverse populations.