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Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia

A Randomized Clinical Trial

Lange, E.M.S.; Wong, C.A.; Fitzgerald, P.C.; Davila, W.F.; Rao, S.; McCarthy, R.J.; Toledo, P.

Obstetric Anesthesia Digest: March 2019 - Volume 39 - Issue 1 - p 5
doi: 10.1097/01.aoa.0000552875.68997.b3
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(Anesthesiology. 2018;128:745–753)

Neuraxial labor analgesia is usually administered by a combination of continuous infusion, clinician-administered boluses, and patient-administered boluses via patient-controlled epidural analgesia (PCEA). While the ideal labor analgesia regimen has yet to be determined, studies suggest programmed intermittent epidural boluses (PIEB) may be a superior option. PIEB has been shown to require less local anesthetic, reduce need for clinician intervention, and results in less motor block compared with a continuous infusion. High-rate delivery of epidural boluses may improve drug distribution when compared with low-rate administration as it increases delivery pressure at the catheter tip. The authors hypothesized that compared with women maintained using a low-rate PIEB and PCEA regimen, a high rate PIEB and PCEA regimen would result in less breakthrough pain, reduced PCEA request-to-delivery ratios, decreased bupivacaine consumption, and fewer provider-administered supplemental boluses.

Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL

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