McKenzie C P, Cobb B, Riley E T, Carvalho B
Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA.
Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA.
Int J Obstet Anesth. 2016 May;26:32-8. doi: 10.1016/j.ijoa.2015.11.005. Epub 2015 Nov 27.
The aim of this impact study was to compare the analgesic efficacy and side effect profile of programmed intermittent epidural boluses (PIEB)+patient-controlled epidural analgesia (PCEA) to continuous epidural infusion (CEI)+PCEA for maintenance labor analgesia after the introduction of PIEB at our institution.
We conducted a retrospective analysis after replacing the background CEI with PIEB for our labor PCEA. Pre-change pump settings were CEI 12mL/h with PCEA (12mL bolus, lockout 15min); PIEB settings were a 9mL bolus every 45min with PCEA (10mL bolus, lockout 10min). We compared medical records of all women receiving epidural or combined spinal-epidural labor analgesia for vaginal delivery for two months before PIEB implementation to a two-month period of PIEB utilization following a five-month introductory familiarization period. The primary outcome was the proportion of women requiring rescue clinician boluses.
Fewer patients in the PIEB group required rescue clinician boluses compared to the CEI group (12% vs. 19%, P=0.012). Time to first rescue bolus request and total bolus dose were not different. Peak (median [IQR]) pain scores were 2[0-5] with CEI and 0[0-4] with PIEB. There was no difference in instrumental delivery rates.
Using PIEB compared to CEI as the background maintenance epidural analgesia method in conjunction with PCEA reduced the number of women requiring clinician rescue boluses while providing comparable labor analgesia. The findings of this clinical care impact study confirm the results of randomized controlled studies and suggest PIEB may be a preferable technique to CEI for the maintenance of labor analgesia.
本影响研究的目的是比较在我们机构引入程序化间歇性硬膜外推注（PIEB）+患者自控硬膜外镇痛（PCEA）与持续硬膜外输注（CEI）+PCEA用于维持分娩镇痛的镇痛效果和副作用情况。
在将分娩PCEA的背景CEI替换为PIEB后，我们进行了一项回顾性分析。更换前的泵设置为CEI 12mL/h加PCEA（12mL推注，锁定时间15分钟）；PIEB设置为每45分钟9mL推注加PCEA（10mL推注，锁定时间10分钟）。我们将PIEB实施前两个月接受硬膜外或腰麻-硬膜外联合分娩镇痛以进行阴道分娩的所有女性的病历与经过五个月的引入熟悉期后PIEB使用的两个月期间的病历进行了比较。主要结局是需要临床医生进行抢救推注的女性比例。
与CEI组相比，PIEB组需要临床医生进行抢救推注的患者更少（12%对19%，P = 0.012）。首次抢救推注请求的时间和总推注剂量没有差异。CEI组的峰值（中位数[四分位间距]）疼痛评分为2[0 - 5]，PIEB组为0[0 - 4]。器械助产率没有差异。
与CEI相比，使用PIEB作为背景维持硬膜外镇痛方法联合PCEA可减少需要临床医生进行抢救推注的女性数量，同时提供相当的分娩镇痛效果。这项临床护理影响研究的结果证实了随机对照研究的结果，并表明PIEB可能是比CEI更适合维持分娩镇痛的技术。
