Zhou Yilu, Ma Ruijing, Tang Jian, Song Yujie, Liu Zhiqiang, Xu Zhendong
From the Department of Anaesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China (YZ, RM, JT, YS, ZX), the Department of Anaesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China (ZL).
Eur J Anaesthesiol. 2025 Sep 1;42(9):783-790. doi: 10.1097/EJA.0000000000002214. Epub 2025 Jun 20.
Dural puncture epidural block (DPE) with programmed intermittent epidural bolus (PIEB) delivery provides effective analgesia for labour pain; however, it poses a risk of a high level of block.
To investigate the effect different pump speeds for a PIEB on maternal sensory block after DPE.
A prospective, double-blind, randomised controlled study.
An Obstetrics and Gynaecology Hospital, China, from June 2023 to December 2023.
Labour analgesia was administered to 120 nulliparous women with a singleton pregnancy during the first stage of labour.
After DPE insertion, women using labour analgesia were randomly allocated into a low-speed group (120 ml h -1 ), a medium-speed group (240 ml h -1 ) or a high-speed group (360 ml h -1 ). Epidural catheters were placed at L3/4 or L4/5, and epidural analgesia was maintained with a PIEB; 10 ml every 60 min using 0.1% ropivacaine with 0.3 μg ml -1 sufentanil.
The primary outcome was the highest level of upper sensory block from administering DPE combined with PIEB until delivery.
A total of 143 parturients were approached and 120 were randomised to three groups of 40. There were no statistically significant differences between the three groups at any time in either the highest sensory block ( P = 0.14) or the upper sensory block ( P = 0.27). Lower sensory ( P = 0.20) and sacral blocks ( P = 0.84) did not differ between groups. Nevertheless, the highest visual analogue pain scores (> 3) after labour anaesthesia was statistically different between the three groups ( P = 0.023). Satisfaction with labour analgesia was significantly different between groups ( P = 0.006). No differences in other secondary outcomes were noted.
DPE with PIEB delivery of 360 ml h -1 did not produce higher sensory block levels than either 240 ml h -1 or 120 ml h -1 . However, in secondary outcomes, the high speed delivery did provide more effective labour analgesia and higher satisfaction than low speed delivery.
硬膜外穿刺硬膜外阻滞（DPE）联合程序化间歇性硬膜外推注（PIEB）给药可有效缓解分娩疼痛；然而，它存在高位阻滞的风险。
探讨PIEB不同泵速对DPE后产妇感觉阻滞的影响。
一项前瞻性、双盲、随机对照研究。
中国一家妇产医院，时间为2023年6月至2023年12月。
120名单胎初产妇在第一产程接受分娩镇痛。
插入DPE后，使用分娩镇痛的产妇被随机分为低速组（120ml/h）、中速组（240ml/h）或高速组（360ml/h）。硬膜外导管置于L3/4或L4/5间隙，采用PIEB维持硬膜外镇痛；每60分钟推注10ml含0.3μg/ml舒芬太尼的0.1%罗哌卡因。
主要观察指标是从实施DPE联合PIEB至分娩期间的最高上感觉阻滞平面。
共纳入143名产妇，120名被随机分为三组，每组40名。三组在任何时间的最高感觉阻滞（P = 0.14）或上感觉阻滞（P = 0.27）方面均无统计学显著差异。组间下感觉阻滞（P = 0.20）和骶部阻滞（P = 0.84）无差异。然而，分娩麻醉后最高视觉模拟疼痛评分（>3）在三组间有统计学差异（P = 0.023）。组间对分娩镇痛的满意度有显著差异（P = 0.006）。未观察到其他次要观察指标的差异。
PIEB泵速为360ml/h的DPE产生的感觉阻滞平面并不高于240ml/h或120ml/h。然而，在次要观察指标方面，高速给药比低速给药提供了更有效的分娩镇痛和更高的满意度。
