Labor Pain
Conditions
Keywords
Pregnant, Labor, Epidural, Analgesia, Intermittent
Brief summary
Enhanced patient safety and satisfaction have contributed to growing use of epidural labor analgesia. Epidural analgesia appears to be currently the most effective technique in reducing pain during labor. However, reduction in total dose of local anesthetic and thus motor blockade is crucial to improve the obstetric outcome. This technique has evolved from intermittent boluses by anesthesiologists to the current standard labor epidural analgesic regimens in many institutions in North America and Europe that consist of a local anesthetic in combination with an opioid delivered via continuous epidural infusion (CEI) with or without patient-controlled epidural analgesia (PCEA) boluses. Recently,a new mode of administration has been used: regular bolus of low concentration local anesthetic + intermittent bolus (PIEB). This technique would offer safe and superior quality labor analgesia and greater maternal satisfaction by reducing total amount of the drug combination. The primary outcome was to evaluate the analgesic efficacy of PIEB epidural drug delivery in terms of visual analogue scale satisfaction (VAS) score in a large cohort of patients. The secondary outcomes were to measure the degree of motor blockade, neonatal and obstetric outcomes, total drug dose and incidence of pain that required top-up administration (breakthrough pain)
Detailed description
Patients were explained about the procedure and written informed consent was obtained. Healthy term primi or second gravid parturients (aged \>18 years) with a singleton, live fetus in vertex presentation when in active stage of labor with cervical dilation of 3-5 cm were recruited in the study after they requested epidural for pain relief. PIEB epidural analgesia was used. Primary outcome was maternal satisfaction during labor and delivery. Our hypothesis was that patients would have a greater level of satisfaction when using PIEB technique. The secondary outcomes were to measure the degree of motor blockade, neonatal and obstetric outcomes.
Interventions
DRUGRopivacaine
Epidural : automatic intermittent boluses associated with patient controlled bolus using ropivacaine
Sponsors
Pierre and Marie Curie University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* healthy term primi or second gravid parturients * aged 18-30 years * singleton, live fetus * vertex presentation * active stage of labor with cervical dilation of 3-5 cm parturients
Exclusion criteria
* Hypertension * no vertex presentation * contraindications to neuraxial blockade
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Verbal Analogue Satisfaction Score | 1 day | VASS: 0-10: 0 = no satisfaction to 10 (total satisfaction) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Apgar score | 1 day | The Apgar test is done by a doctor, midwife, or nurse. The health care provider examines the baby's: * Breathing effort * Heart rate * Muscle tone * Reflexes * Skin color Each category is scored with 0, 1, or 2, depending on the observed condition. |
| Anesthetic rescue | 1 day | Evaluation of the rescue performed by anesthesist over infusion |
| maternal hypotension | 1 day | Evaluation of adverse events over epidural infusion (mean arterial pressure\< 65 mmHg) |
| fetal heart rate | 1 day | Fetal heart sounds were monitored with a continuous Doppler machine |
| Motor blockade | 1 day | Bromage score for maternal motor block |
| nausea | 1 day | Number of maternal nausea event |
Countries
France
Outcome results
None listed