Programmed intermittent epidural bolus for labour analgesia during first stage of labour: a sequential allocation trial to determine the effective interval time between boluses of a fixed volume of 2.5 mL of bupivacaine 0.25% plus fentanyl 8 μg•mL-1

Purpose We studied the programmed intermittent epidural bolus (PIEB) time interval between boluses of 2.5 mL of bupivacaine 0.25% with fentanyl 8 mu g center dot mL(-1) to produce effective analgesia in 90% of women (EI90) during the first stage of labour. Methods In a double-blind sequential allocation trial using a biased coin up-and-down design to determine the EI90, the PIEB boluses of 2.5 mL of 0.25% bupivacaine plus fentanyl 8 mu g center dot mL(-1) were delivered at varying intervals-60, 50, 40, and 30 min. The primary outcome was the adequate response of the patient to the PIEB regimen, defined as no use of supplemental analgesia for six hours or until the first stage of labour was completed, whichever came first. The secondary outcomes were the upper sensory block level to ice, motor block and hypotension. The isotonic regression with extrapolation approach was used to estimate the EI90. Results In the 20 women studied, the estimated EI90 was 20 (95% CI, 5.9 to 28.8) min. For the secondary outcomes, we classified women into those assigned to 30 min (16 women) and those assigned to more than 30 min (four women). The median upper sensory block for women in the 30-min group and more than 30 min were T6 (or T5) and T7, respectively. No participants experienced motor block. Hypotension occurred in one patient in the 30-min group. Conclusion The estimated EI90 for boluses of 2.5 mL of bupivacaine 0.25% with fentanyl 8 mu g center dot mL(-1) was 20 (95% CI, 5.9 to 28.8) min. These results suggest that there is no advantage in using this regimen compared with those reported in the literature using the same dose of bupivacaine in concentrations of 0.0625% and 0.125%.

Automated summary

The study found that injecting 2.5 mL of bupivacaine 0.25% with fentanyl 8 mu g center dot mL(-1) every 20 minutes during the first stage of labor can produce effective analgesia. Additionally, there is no significant advantage in using this regimen compared to literature reports using the same dose of bupivacaine at concentrations of 0.0625% and 0.125%.