Department of Anesthesiology, Women's Hospital, Zhejiang University School of Medicine, Xueshi Road 1#, Hangzhou, China.
J Anesth. 2022 Feb;36(1):32-37. doi: 10.1007/s00540-021-03002-x. Epub 2021 Sep 17.
The aim of this study was to assess the efficacy of programmed intermittent epidural boluses (PIEB) in postoperative pain management compared with continuous epidural infusion (CEI) after cesarean delivery.
A total of 58 participants were randomly allocated to receive PIEB (3 mL bolus every 60 min) or CEI (3 mL/h) for postoperative analgesia after undergoing elective cesarean section under combined spinal-epidural anesthesia. Both groups had the same epidural solution containing ropivacaine 0.2% plus fentanyl 2 µg/mL. The primary outcome was postoperative pain score at rest and mobilization at 6, 12, 24, and 48 h. The secondary outcomes were the total amount of ropivacaine used in the 48 h study period and the time to the first PCEA bolus.
Data from 58 women were analyzed. There was a reduction in pain verbal numerical rating scores at 12 h in patients receiving PIEB compared with CEI at rest [2 (1.75-3) vs. 3 (2-4), p = 0.011]; and on movement [4 (3-5) vs. 5 (4-6), p = 0.038]. No differences were found in pain scores at any other time-point up to 48 h. Total ropivacaine consumption at 48 h was less in the PIEB group compared with the CEI group [316 mg (304-321) vs. 336 mg (319-344), p = 0.001].
Postoperative epidural analgesia for patients who underwent cesarean delivery with PIEB compared with CEI resulted in less ropivacaine usage while providing comparable analgesia.
本研究旨在评估程控硬膜外间断推注（PIEB）与连续硬膜外输注（CEI）用于剖宫产术后镇痛的疗效。
58 例患者随机分为 PIEB 组（每 60 分钟推注 3 毫升）或 CEI 组（3 毫升/小时），行腰硬联合麻醉下择期剖宫产术后接受硬膜外镇痛。两组硬膜外均采用罗哌卡因 0.2%加芬太尼 2μg/ml 的相同溶液。主要结局是术后 6、12、24 和 48 小时静息和活动时的疼痛评分。次要结局是 48 小时研究期间罗哌卡因的总用量和首次使用患者自控硬膜外镇痛（PCEA）推注的时间。
58 例女性患者的数据被分析。与 CEI 组相比，PIEB 组患者在静息时 12 小时的疼痛数字评分量表（VRS）评分降低[2（1.75-3）比 3（2-4），p=0.011]；在运动时[4（3-5）比 5（4-6），p=0.038]。在 48 小时内的其他任何时间点，疼痛评分均无差异。48 小时时 PIEB 组罗哌卡因总用量少于 CEI 组[316mg（304-321）比 336mg（319-344），p=0.001]。
与 CEI 相比，剖宫产术后行 PIEB 的患者硬膜外镇痛可减少罗哌卡因的使用，同时提供等效的镇痛效果。
