Breakthrough Pain in Labour. a Randomized Double Blind Clinical Trial Comparing Programed intermitent Epidural Boluses (Pieb) Versus Patient Controlled Epidural Analgesia (Pcea) With Epidural or Combined Spinal Epidural Technique : Preliminary Results

• Main Author: Diez-Picazo, Luis D
• Format: Web Resource
• Language: English
• Published: Morressier 01.01.2017
• DOI: 10.26226/morressier.57108e2ed462b80290b4a1f1

Background and goal of study: The aim w as to know the incidence of breakthrough pain (BP)comparing tw o analgesic regimes. We also evaluated the BP incidence betw een epidural (EA) andcombined spinal epidural (CSE) analgesia.Materials and methods: We performed a randomized double blind clinical trial on nulliparousw omen (18-40 yrs old), w ith a cervical dilatation < 4cm at singleton term pregnancy. Exclusioncriteria w ere contraindication for EA and the presence of systemic disease. Patients w ererandomized to receive EA w ith PCEA (group 1), EA plus PIEB (group 2), CSE w ith PCEA (group 3), orCSE plus PIEB (group 4). The anaesthesiologist w ho performed the epidural block w as blinded forthe analgesic regime, and pain w as assessed by a third anaesthesiologist blinded for the techniqueor analgesic regime. All patients had a background epidural infusion (0.125% levo-bupivacaine w ith1.45 mcg/ml fentanyl, 5 ml/h.). PCEA groups w ere set w ith 10 ml boluses (20 min lockout interval).PIEB groups received 10ml bolus per hour (20 min lock time w ith PCEA). BP w as defined as the needfor analgesia due to pain u22654 in visual analog scale (VAS) and treated w ith 10ml bolus of epiduralinfusion. Failed block w as considered w hen VAS w as >3 sixty minutes after epidural catheterinsertion and patients w ere excluded from the analysis. We recorded BP episodes, PCEA boluses,total volume of infusion, VAS pain scores, delivery outcomes, and maternal satisfaction.Results: 60 patients w ere included. Groups w ere homogeneous. 93% of PIEB groups patients had0 episodes of BP, and 95% of PCEA patients had at least 1 episode of BP. (p=0,002). There w asless BP episodes in PIEB groups (mean 0.5 u00b1 0.9 in group 2; 1.2 u00b1 1.8 in group 4) compared w ithcontrol groups (2.4 u00b1 1.7 in group 1; 2.9 u00b1 1.7 in group 3) (P < 0.05). Total local anaesthetic indemand for BP w as significantly low er in PIEB (mean 4.1 u00b1 7.2 ml in group 2; 95%; 9.4 u00b1 17.7 ml ingroup 4) compared w ith PCEA groups (28.8 u00b1 16.8 ml in group 1; 28.0 u00b1 16.0 ml in group 3) (P <0.05). There w ere no difference betw een CSE versus EA groups regarding number of BP episodesand PCEA boluses (P >0.05). VAS w ere low er in CSE compared w ith epidural groups at 30 min (P <0.001), but they w ere comparable during labour. The incidence of failed block w as 11.7%.Conclusion: PIEB reduced the incidence of BP during labour compared to PCEA. CSE techniquecould not reduce the number of episodes of BP after the first 30 minutes.