Programmed intermittent epidural bolus for labour analgesia: a randomized controlled trial comparing bolus delivery speeds of 125 mL.hr-1versus 250 mL.hr-1

Purpose Programmed intermittent epidural bolus (PIEB) provides better analgesia for labour pain than continuous epidural infusion does. Nevertheless, commonly used PIEB regimens are associated with high sensory block. We hypothesized that a PIEB technique with slower bolus delivery speed would produce lower sensory levels. Methods We recruited term nulliparous women with singleton pregnancies during the first stage of labour. All participants had an American Society of Anesthesiologists Physical Status score of II-III, had epidural catheters placed at L3/4, and had epidural analgesia maintained with PIEB 10 mL every 40 min using 0.0625% bupivacaine with fentanyl 2 mu g.mL(-1). Women were randomized to receive PIEB delivered at 250 mL.hr(-1) (G250) or 125 mL.hr(-1) (G125). The study was completed six hours after the loading dose or at full cervical dilatation, whichever occurred first. The primary outcome was the presence of sensory block to ice >= T6 in at least one assessment during the study period (maximum six hours). Results We analyzed data from 90 women. The proportion of women presenting sensory block >= T6 at any time was not different between G125 and G250 groups (60.0% vs 64.4%; difference, -4.4%; 95% confidence interval [CI], -24.5 to 15.6; P = 0.66). The median [interquartile range] highest sensory block level was also not different between G125 and G250 groups (T6 [T7-T5] vs T5 [T7-T5], P = 0.39). Women in the G125 group had a lower incidence of hypotension than women in the G250 group did (11.1% vs 33.3%; difference, -22.2%; 95% CI, -38.8 to -5.67; P = 0.01). Quality of analgesia and patient satisfaction were not different between groups. Conclusion The maintenance of epidural analgesia with a PIEB delivery speed of 125 mL.hr(-1) did not produce lower sensory block levels when compared with 250 mL.hr(-1). The slower injection speed regimen was associated with lower incidence of hypotension, but this secondary finding warrants confirmation in a future trial.