Department of Gynecology and Obstetrics, School of Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Department of Gynecology and Obstetrics, Buergerhospital, Nibelungenallee 37-41, 605318, Frankfurt, Germany.
Arch Gynecol Obstet. 2024 Nov;310(5):2399-2403. doi: 10.1007/s00404-024-07591-2. Epub 2024 Jun 16.
The aim of this study is to compare and evaluate the obstetrical differences between three techniques, including the programmed intermittent epidural bolus (PIEB), the patient-controlled epidural analgesia (PCEA), and the continuous epidural analgesia (CEA).
This is a retrospective cohort study that investigates the obstetrical outcomes of 2240 patients who received EA during labor in a tertiary maternal unit over the course of 9 years (2011-2018). The only inclusion criterion was the use of epidural analgesia during childbirth and the only exclusion criteria were multiplets' gestation. Multivariate logistic regression, Kruskal-Wallis test, and the log-rank test were utilized to compare the differences between the three EA techniques in terms of cesarean section rate, the incidence of perineal tears, the use of Oxytocin, the duration of labor, and the incidence of paresthesia.
Out of the 2240 included deliveries; 1084 utilized PIEB, 1086 PCEA, and 70 CEA techniques. The incidence of Cesarean section was the highest in the CEA group (45.7%) compared to PIEB (24.8%) and PCEA (24.4%) P < 0.001. A significantly shorter duration of labor (vaginal delivery) was observed in the PCEA group (n: 821, 336.7 min) compared to the PIEB group (n: 814, 368.8 min) P < 0.001. There were no statistically significant differences in the incidence of perineal tears, the need of uterotonics, and the incidence of paresthesia.
The results of this study indicate that the PIEB and PCEA techniques are superior to the CEA technique when it comes to analgesia during childbirth. In this study, the PCEA technique seems to be the best-suited technique for childbirth, since it had a significantly shorter duration of labor than the PIEB technique.
本研究旨在比较和评估三种技术（包括程序化间歇硬膜外推注（PIEB）、病人自控硬膜外镇痛（PCEA）和连续硬膜外镇痛（CEA））在产科方面的差异。
这是一项回顾性队列研究，调查了 9 年间（2011-2018 年）在一家三级产科单位分娩期间接受 EA 的 2240 名患者的产科结局。唯一的纳入标准是分娩时使用硬膜外镇痛，唯一的排除标准是多胎妊娠。采用多变量逻辑回归、Kruskal-Wallis 检验和对数秩检验比较三种 EA 技术在剖宫产率、会阴撕裂发生率、催产素使用、产程和感觉异常发生率方面的差异。
在纳入的 2240 次分娩中，1084 次使用 PIEB、1086 次使用 PCEA 和 70 次使用 CEA 技术。CEA 组（45.7%）的剖宫产率最高，与 PIEB（24.8%）和 PCEA（24.4%）相比，P<0.001。PCEA 组（n=821，336.7 分钟）的产程（阴道分娩）明显短于 PIEB 组（n=814，368.8 分钟），P<0.001。会阴撕裂发生率、催产素需求和感觉异常发生率无统计学差异。
本研究结果表明，PIEB 和 PCEA 技术在分娩镇痛方面优于 CEA 技术。在这项研究中，PCEA 技术似乎是最适合分娩的技术，因为它的产程比 PIEB 技术明显缩短。
