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Automated intermittent epidural boluses improve analgesia induced by intrathecal fentanyl during labour

[L’administration automatisée de bolus intermittents améliore l’analgésie induite par du fentanyl intrathécal pendant le travail]

Sebastian M.H. Chua, MMED^* and Alex T.H. Sia, MMED

^* From the Departments of Anaesthesia, Singapore General Hospital, and
the KK Women and Children’s Hospital, Singapore.

Address correspondence to: Dr. Sebastian M.H. Chua, Department of Anaesthesia, Singapore General Hospital, Outram Rd, Singapore 169608. Phone: 65-6321-4220; Fax: 65-6224-1792; E-mail: sebnjess{at}singnet.com.sg

Purpose: We compared the efficacy of epidural continual intermittent boluses (CIB) with a continuous epidural infusion (CEI) in prolonging labour analgesia induced by the combined spinal epidural (CSE) technique.

Methods: CSE was instituted in 42 nulliparous parturients at the L3 to 4 level with intrathecal (IT) fentanyl 25 µg followed by an epidural test dose of 3 mL of 1.5% lidocaine. These parturients were then randomly assigned to receive either epidural CIB (n = 21) or CEI (n = 21) with 0.1% ropivacaine and fentanyl 2 µg·mL^–1. For the CIB, 5 mL boluses were given hourly, with the first bolus 30 min postinduction. CEI at the rate of 5 mL·hr^–1 was initiated in the minute after CSE. The duration of analgesia, pain score, degree of sensorimotor block were compared.

Results: From Kaplan Meier survival analysis, the duration of analgesia was significantly longer in CIB (mean survival time 239 ± SD 24 min vs 181 ± 17, P < 0.05 using log rank test). During the first three hours postblock, the median sensory block to cold was higher in CIB (P < 0.05, Mann U Whitney test) but no difference in blood pressure was detected [P > 0.05, repeated measure analysis of variance (RMANOVA)]. The serial pain scores were lower in the CIB (P < 0.05, RMANOVA).

Conclusion: CIB prolonged the duration and improved the quality of analgesia. CIB could have resulted in an improved spread of analgesics in the epidural space or encouraged a direct passage of infusate into the IT space. This could have also rendered a higher sensory block to cold in the CIB group. CIB is a good alternative to CEI for the maintenance of epidural analgesia after CSE.

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