Karol D, Zarour S, Aptekman B, Lavie A, Weiniger C F, Rabkin V
Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Affiliated to the Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Affiliated to the Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Int J Obstet Anesth. 2025 Aug;63:104378. doi: 10.1016/j.ijoa.2025.104378. Epub 2025 Apr 25.
Studies suggest that programmed intermittent epidural bolus (PIEB) with patient-controlled epidural analgesia (PCEA) for labor epidural analgesia maintenance provides better analgesia, greater maternal mobility during labor, and improved obstetric outcomes compared with continuous epidural infusion (CEI) with PCEA. However instrumental vaginal delivery rates with PIEB/PCEA remain underreported.
Following implementation of PIEB/PCEA in our institution, a retrospective study was conducted comparing outcomes with CEI/PCEA (July to December 2020) vs. PIEB/PCEA (July to December 2021). The primary outcome was the vacuum-assisted vaginal delivery rate. Secondary outcomes were the number of physician-administered epidural boluses, the rate of episiotomies and vaginal lacerations, rate of conversion to cesarean delivery and the rate of successful conversion to epidural surgical anesthesia in the latter. There were no exclusion criteria.
There were 7610 cases with labor epidural analgesia, CEI/PCEA 3934 (51.7%) and PIEB/PCEA 3676 (48.3%). There was no difference in the rate of vacuum-assisted delivery with PIEB/PCEA (14.1%) or CEI/PCEA (13.3%) (OR 1.07, 95% CI 0.94-1.22, P =0.34). With PIEB/PCEA, women were less likely to receive physician-administered epidural boluses.
PIEB/PCEA was associated with comparable rates of vacuum-assisted delivery as CEI/PCEA, with lower rates of physician-administered epidural boluses, suggesting better quality of labor epidural analgesia with PIEB/PCEA.
研究表明，与采用患者自控硬膜外镇痛（PCEA）的持续硬膜外输注（CEI）相比，采用程序化间歇性硬膜外推注（PIEB）联合PCEA维持分娩硬膜外镇痛可提供更好的镇痛效果，增加产妇分娩期间的活动能力，并改善产科结局。然而，关于PIEB/PCEA的器械助产率的报道仍然不足。
在我们机构实施PIEB/PCEA后，进行了一项回顾性研究，比较了CEI/PCEA（2020年7月至12月）与PIEB/PCEA（2021年7月至12月）的结局。主要结局是真空辅助阴道分娩率。次要结局包括医生给予硬膜外推注的次数、会阴切开术和阴道撕裂伤的发生率、剖宫产率以及后者成功转换为硬膜外手术麻醉的发生率。没有排除标准。
共有7610例分娩硬膜外镇痛病例，CEI/PCEA组3934例（51.7%），PIEB/PCEA组3676例（48.3%）。PIEB/PCEA组（14.1%）和CEI/PCEA组（13.3%）的真空辅助分娩率没有差异（OR 1.07，95%CI 0.94-1.22，P =0.34）。采用PIEB/PCEA时，女性接受医生给予硬膜外推注的可能性较小。
PIEB/PCEA与CEI/PCEA的真空辅助分娩率相当，医生给予硬膜外推注的次数较低，表明PIEB/PCEA的分娩硬膜外镇痛质量更好。
