Comparison between different epidural analgesia modalities for labor

Introduction: In recent years new modalities of epidural analgesia maintenance (EA) have been introduced. Objective: The objective of this study is to compare different modalities of EA maintenance for childbirth relating the time of expulsive and dilatation, motor blockade and delivery instrumentation (caesarean section, sucker, forceps, eutocic delivery or non-instrumented delivery). Material and methods: Patients admitted for labor in the University Hospital Nuestra Senora de Candelaria between January 2013 and December 2015 were included. Independent modalities of EA, continuous infusion (CI), continuous infusion plus analgesia patient controlled epidural analgesia were determined as independent variables (CI + PCEA) and intermittent programmed epidural boluses plus patient controlled epidural analgesia (PIEB + PCEA). Results: There are no differences in expulsive time or dilation. There is a difference in the type of instrumentation, caesarean section, sucker, forceps, eutocic delivery or non-instrumented delivery (P> .05), with the percentage of eutocic deliveries in PIEB+ PCEA of 66 versus 60 in CI and 65 in CI + PCEA. The percentage of caesarean sections was 23 in CI, in CI + PCEA and PIEB+ PCEA of 17. CI increases by 27% the possibility of instrumented deliveries respect to PIEB+ PCEA, there is no difference between CI + PCEA and PIEB+ PCEA. The motor blockade at 60 and 90 minutes reaches lower values with PIEB + PCEA with an average of 0 and a range of 0-1, compared to CI + PCEA 0 (0-4). Satisfaction with CI + PCEA ranges from 2-10 and with PIEB + PCEA 0-10. Conclusion: It is possible to say that PIEB + PCEA is associated with higher frequency of non-instrumented deliveries. The possibility of instrumented deliveries increases with CI versus PIEB + PCEA. There is less motor block with PIEB + PCEA than with CI + PCEA. There are no differences in time of dilatation, expulsion, or patient satisfaction. (C) 2019 Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del Dolor. Published by Elsevier Espana, S.L.U. All rights reserved.