Carvalho Brendan, George Ronald B, Cobb Benjamin, McKenzie Christine, Riley Edward T
From the *Department of Anesthesia, Stanford University School of Medicine, Stanford, CA; and †Department of Women's & Obstetric Anesthesia, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Anesth Analg. 2016 Oct;123(4):965-71. doi: 10.1213/ANE.0000000000001407.
Programmed intermittent epidural bolus (PIEB) is an exciting new technology that has the potential to improve the maintenance of epidural labor analgesia. PIEB compared with a continuous epidural infusion (CEI) has the potential advantage of greater spread within the epidural space and therefore better sensory blockade. Studies have demonstrated a local anesthetic-sparing effect, fewer instrumental vaginal deliveries, less motor blockade, and improvements in maternal satisfaction with PIEB compared with CEI. However, the optimal PIEB regimen and pump settings remain unknown, and there are a number of logistical issues and practical considerations that should be considered when implementing PIEB. The PIEB bolus size and interval, PIEB start time delay period, and patient-controlled epidural analgesia bolus size and lockout time can influence the efficacy of PIEB used for epidural labor analgesia. Educating all members of the health care team is critical to the success of the technique. This review summarizes the role of PIEB for the maintenance of labor analgesia, outlines implementation strategies, suggests optimal settings, and presents potential limitations of the technique.
程序化间歇性硬膜外推注（PIEB）是一项令人兴奋的新技术，它有潜力改善硬膜外分娩镇痛的维持效果。与持续硬膜外输注（CEI）相比，PIEB在硬膜外间隙内有更大的扩散潜力，因此感觉阻滞效果更好。研究表明，与CEI相比，PIEB具有节省局部麻醉药的作用、减少器械助产阴道分娩、减少运动阻滞，并提高产妇满意度。然而，最佳的PIEB方案和泵设置仍然未知，在实施PIEB时，有许多后勤问题和实际考虑因素需要考虑。PIEB推注量和间隔时间、PIEB开始时间延迟期以及患者自控硬膜外镇痛推注量和锁定时间会影响用于硬膜外分娩镇痛的PIEB的效果。对医疗团队的所有成员进行培训对该技术的成功至关重要。本综述总结了PIEB在维持分娩镇痛中的作用，概述了实施策略，提出了最佳设置，并介绍了该技术的潜在局限性。
