Department of Anesthesiology of The First People's Hospital of Changde City, Changde, Hunan, China.
Obstetrical Department of The First People's Hospital of Changde City, Changde, Hunan, China.
Medicine (Baltimore). 2022 Feb 4;101(5):e28742. doi: 10.1097/MD.0000000000028742.
To evaluate the efficacy and safety of programmed intermittent epidural bolus (PIEB) in parturients.
The PubMed, Embase, and the Cochrane Library (from inception to July 2021) were searched for identification of randomized placebo-controlled trials in which PIEB was applied in parturients. The outcomes were the effect of analgesia, satisfaction score, mode of delivery, duration of labor, neonatal condition, and adverse events. The pooled odds ratios (OR), weighted mean difference (WMD), and 95% confidence intervals (CIs) were calculated using random- and fixed-effects models.
PIEB was found to be associated with decreased total consumption of ropivacaine (WMD = -15.83, 95% CI: -19.06 to -12.60, P < .00001; I2 = 61%; P for heterogeneity = .04), total consumption of sufentanil (WMD = -4.93, 95% CI: -6.87 to 2.98, P < .00001; I2 = 68%; P for heterogeneity = .05), numbers of patients who require patient-controlled epidural analgesia bolus (OR = 0.27, 95% CI: 0.14-0.51, P < .0001; I2 = 65%; P for heterogeneity = .01), the number of attempts (WMD = -4.12, 95% CI: -7.21 to -1.04, P = .009; I2 = 100%; P for heterogeneity < .00001), rate of breakthrough pain (OR = 0.47, 95% CI: 0.28-0.80, P = .005; I2 = 47%; P for heterogeneity = .09). Eight studies focus on the duration of analgesia. After by meta-analysis, we found that the pain visual analogue scale (VAS) score at 30 minutes, 2 hours, 4 hours, and 5 hours in PIEB group was significantly lower when compared with control group, (WMD = -0.15, 95% CI: -0.26 to -0.04, P = .006; I2 = 0%; P for heterogeneity = .64), (WMD = -0.79, 95% CI: -1.32 to 0.25, P = .004; I2 = 97%; P for heterogeneity < .00001), (WMD = -1.00, 95% CI: -1.08 to -0.91, P < .00001; I2 = 0%; P for heterogeneity = .67), (WMD = -1.81, 95% CI: -3.23 to -0.39, P = .01; I2 = 98%; P for heterogeneity < .00001), respectively. Nineteen studies discussed the mode of delivery between 2 groups. The results suggest that the rate of normal delivery is significantly higher in PIEB group compared with control group (OR = 1.37, 95% CI: 1.08-1.75, P = .01). The time of first and second stage of labor are significantly shorter in PIEB group compared with control group, the result is (WMD = -10.52, 95% CI: -14.74 to 4.76, P < .00001; I2 = 0%; P for heterogeneity = .86), (WMD = -1.48, 95% CI: -2.26 to -0.69, P = .0002; I2 = 35%; P for heterogeneity = .10), respectively. Thirteen studies concerned the satisfaction score of patients. The satisfaction score of patients in the PIEB group was significantly higher when compared with control group (WMD = 0.91, 95% CI: 0.42-1.39, P = .0003; I2 = 98%; P for heterogeneity < .00001). The Apgar score at 1, 5 minutes in PIEB group are significantly higher (WMD = 0.07, 95% CI: 0.02-0.13 P = .007; I2 = 55%; P for heterogeneity = .04), (WMD = -0.08, 95% CI: -0.12 to -0.05, P < .00001; I2 = 21%; P for heterogeneity = .27), respectively.
PIEB is a good alternative for labor analgesia with better analgesic effect, maternal and infant outcome.
评估程序化间歇性硬膜外推注（PIEB）在产妇中的疗效和安全性。
检索 PubMed、Embase 和 Cochrane 图书馆（从成立到 2021 年 7 月），以确定在产妇中应用 PIEB 的随机安慰剂对照试验。结局为镇痛效果、满意度评分、分娩方式、产程时间、新生儿情况和不良事件。使用随机效应和固定效应模型计算合并优势比（OR）、加权均数差（WMD）和 95%置信区间（CI）。
PIEB 与罗哌卡因总消耗量减少相关（WMD=-15.83，95%CI：-19.06 至-12.60，P<0.00001；I²=61%；P 异质性=0.04）、舒芬太尼总消耗量减少（WMD=-4.93，95%CI：-6.87 至-2.98，P<0.00001；I²=68%；P 异质性=0.05）、需要自控硬膜外镇痛推注的患者数量减少（OR=0.27，95%CI：0.14-0.51，P<0.0001；I²=65%；P 异质性=0.01）、尝试次数减少（WMD=-4.12，95%CI：-7.21 至-1.04，P=0.009；I²=100%；P 异质性<0.00001）、突破性疼痛发生率降低（OR=0.47，95%CI：0.28-0.80，P=0.005；I²=47%；P 异质性=0.09）。八项研究专注于镇痛持续时间。经过荟萃分析，我们发现 PIEB 组在 30 分钟、2 小时、4 小时和 5 小时时的疼痛视觉模拟评分（VAS）显著低于对照组（WMD=-0.15，95%CI：-0.26 至-0.04，P=0.006；I²=0%；P 异质性=0.64）、（WMD=-0.79，95%CI：-1.32 至 0.25，P=0.004；I²=97%；P 异质性<0.00001）、（WMD=-1.00，95%CI：-1.08 至-0.91，P<0.00001；I²=0%；P 异质性=0.67）、（WMD=-1.81，95%CI：-3.23 至-0.39，P=0.01；I²=98%；P 异质性<0.00001）。19 项研究比较了两组的分娩方式。结果表明，PIEB 组的自然分娩率明显高于对照组（OR=1.37，95%CI：1.08-1.75，P=0.01）。PIEB 组第一产程和第二产程的时间明显短于对照组，结果分别为（WMD=-10.52，95%CI：-14.74 至 4.76，P<0.00001；I²=0%；P 异质性=0.86）、（WMD=-1.48，95%CI：-2.26 至-0.69，P=0.0002；I²=35%；P 异质性=0.10）。13 项研究关注患者的满意度评分。与对照组相比，PIEB 组患者的满意度评分明显更高（WMD=0.91，95%CI：0.42-1.39，P=0.0003；I²=98%；P 异质性<0.00001）。PIEB 组的新生儿 1 分钟和 5 分钟时的 Apgar 评分明显更高（WMD=0.07，95%CI：0.02-0.13，P=0.007；I²=55%；P 异质性=0.04）、（WMD=-0.08，95%CI：-0.12 至-0.05，P<0.00001；I²=21%；P 异质性=0.27）。
PIEB 是一种良好的分娩镇痛替代方法，具有更好的镇痛效果和母婴结局。
