Continuous epidural infusion versus programmed-intermittent epidural bolus for labor analgesia and vacuum-assisted vaginal delivery rates: a retrospective cohort study (2020-2021).

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.