Comparision of Intermittent Bolus versus Continuous Infusion of Epidural Labour Analgesia by 0.15% Ropivacaine and Fentanyl: A Randomised Clinical Study UC05-UC09
Banjara Cross, Solapur Road Opposite to Shahapur Dental Clinic, Vijayapur-586103, Karnataka, India.
Introduction: Epidural labour analgesia is considered to be the most effective method to produce pain relief during labour. Programmed Intermittent Epidural Bolus (PIEB) has been observed to have many advantages over Continuous Epidural Infusion (CEI) like reduced incidence of breakthrough pain, local anaesthetic usage, instrumental delivery, shorter second stage of labour and more maternal satisfaction. Administration of local anaesthetic solution as PIEB at regular intervals has shown to spread more extensively in the epidural space compared to CEI, possibly enabling greater efficacy.
Aim: To compare the intermittent bolus versus Continuous Infusion of Epidural Labour Analgesia with the primary objective to measure the total local anaesthetic consumption of 0.15% ropivacaine and fentanyl.
Materials and Methods: The randomised double blind study was carried out on parturient in Obstetrics and Gynaecology Department at Fortis Hospital, Bengaluru, Karnataka, India from June 2014 to June 2015. The present study compared 60 primiparous women (divided into two groups of 30 each). Labour analgesia was provided by bolus of 12 mL of 0.15% ropivacaine and 2 μg/mL fentanyl, after one hour of the initial bolus dose, Group I parturients received 8 mL of 0.15% ropivacaine with fentanyl 2 μg/mL hourly and Group C parturients received same solution as continuous infusion immediately. If patient complained of pain or Visual Analog Scale (VAS) score ≥ 4, additional 8 mL of the same solution was given. Total dose of 0.15% ropivacaine, number of rescue doses, pain scores, motor block and second stage of labour were compared.
Results: The mean age in Group I was 27.93±1.14 and in Group C was 27.87±1.28 years. Total dose of ropivacaine in Group I was 41.45±14.62 mg and in Group C was 59.20±21.12mg (p-value=0.0004). In Group C, at 2nd hour, VAS score (3.03±1.88) was more compared to intermittent bolus group (1.40±2.02), which was statistically significant (p-value=0.002). No motor block was observed in Group I, but two parturients in Group C had modified Bromage score of 4. Second stage of labour was significantly reduced in Group I compared to Group C (p-value<0.001). Less instrumental delivery and more maternal satisfaction was observed in Group I.
Conclusion: Intermittent bolus group required less rescue doses hence, less total local anaesthetic dose with better analgesic efficacy (p=0.002).