Newly Published
Perioperative Medicine  |   January 2018
Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia: A Randomized Clinical Trial
Author Notes
  • From the Department of Anesthesiology (E.M.S.L., P.C.F., W.F.D., S.R., R.J.M., P.T.) and the Center for Healthcare Studies (P.T.), Northwestern University Feinberg School of Medicine, Chicago, Illinois; and the Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa (C.A.W.).
  • This article was presented as an oral presentation at the Society for Obstetric Anesthesia and Perinatology Annual Meeting, Bellevue, Washington, May 11, 2017.
    This article was presented as an oral presentation at the Society for Obstetric Anesthesia and Perinatology Annual Meeting, Bellevue, Washington, May 11, 2017.×
  • Submitted for publication August 9, 2017. Accepted for publication December 7, 2017.
    Submitted for publication August 9, 2017. Accepted for publication December 7, 2017.×
  • Acknowledgments: The authors would like to thank their team of research nurses for their help with recruitment and data collection: Joana Gala, B.S.N., Renee Gora, B.S.N., Yvonne Jekels, B.S.N., Mary Jane Jones, B.S.N., Gabrielle Mazade, M.S.N., Erin Rosell, B.S.N., Suzette Rubner, B.S.N., Megan Stainthorpe, B.S.N., and Adina Suchar, M.S.N., Northwestern Memorial Hospital, Northwestern Medicine, Chicago, Illinois.
    Acknowledgments: The authors would like to thank their team of research nurses for their help with recruitment and data collection: Joana Gala, B.S.N., Renee Gora, B.S.N., Yvonne Jekels, B.S.N., Mary Jane Jones, B.S.N., Gabrielle Mazade, M.S.N., Erin Rosell, B.S.N., Suzette Rubner, B.S.N., Megan Stainthorpe, B.S.N., and Adina Suchar, M.S.N., Northwestern Memorial Hospital, Northwestern Medicine, Chicago, Illinois.×
  • Research Support: Dr. Toledo was supported by a grant from the Robert Wood Johnson Foundation (Princeton, New Jersey) Harold Amos Medical Faculty Development program (award No. 69779). Dr. Davila was supported by a Foundation for Anesthesia Education and Research (FAER) Medical Student Anesthesia Research Fellowship. The content of the manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the Robert Wood Johnson Foundation. Funding for this project was provided by Northwestern University Feinberg School of Medicine Department of Anesthesiology (Chicago, Illinois). Smiths Medical (USA) supplied the CADD-Solis Pain Management System v3.0 with Programmed Intermittent Bolus (PIB) Model 2110 pumps that were used in this study. Smiths Medical had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
    Research Support: Dr. Toledo was supported by a grant from the Robert Wood Johnson Foundation (Princeton, New Jersey) Harold Amos Medical Faculty Development program (award No. 69779). Dr. Davila was supported by a Foundation for Anesthesia Education and Research (FAER) Medical Student Anesthesia Research Fellowship. The content of the manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the Robert Wood Johnson Foundation. Funding for this project was provided by Northwestern University Feinberg School of Medicine Department of Anesthesiology (Chicago, Illinois). Smiths Medical (USA) supplied the CADD-Solis Pain Management System v3.0 with Programmed Intermittent Bolus (PIB) Model 2110 pumps that were used in this study. Smiths Medical had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Reproducible Science: Full protocol available at: elizabeth.lange@northwestern.edu. Raw data available at: elizabeth.lange@northwestern.edu.
    Reproducible Science: Full protocol available at: elizabeth.lange@northwestern.edu. Raw data available at: elizabeth.lange@northwestern.edu.×
  • Correspondence: Address correspondence to Dr. Lange: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E. Huron St. F5-704, Chicago, Illinois 60611. elizabeth.lange@northwestern.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Obstetric Anesthesia / Pain Medicine
Perioperative Medicine   |   January 2018
Effect of Epidural Infusion Bolus Delivery Rate on the Duration of Labor Analgesia: A Randomized Clinical Trial
Anesthesiology Newly Published on January 18, 2018. doi:10.1097/ALN.0000000000002089
Anesthesiology Newly Published on January 18, 2018. doi:10.1097/ALN.0000000000002089
Abstract

Background: Programmed intermittent boluses of local anesthetic have been shown to be superior to continuous infusions for maintenance of labor analgesia. High-rate epidural boluses increase delivery pressure at the catheter orifice and may improve drug distribution in the epidural space. We hypothesized that high-rate drug delivery would improve labor analgesia and reduce the requirement for provider-administered supplemental boluses for breakthrough pain.

Methods: Nulliparous women with a singleton pregnancy at a cervical dilation of less than or equal to 5 cm at request for neuraxial analgesia were eligible for this superiority-design, double-blind, randomized controlled trial. Neuraxial analgesia was initiated with intrathecal fentanyl 25 μg. The maintenance epidural solution was bupivacaine 0.625 mg/ml with fentanyl 1.95 μg/ml. Programmed (every 60 min) intermittent boluses (10 ml) and patient controlled bolus (5 ml bolus, lockout interval: 10 min) were administered at a rate of 100 ml/h (low-rate) or 300 ml/h (high-rate). The primary outcome was percentage of patients requiring provider-administered supplemental bolus analgesia.

Results: One hundred eight women were randomized to the low- and 102 to the high-rate group. Provider-administered supplemental bolus doses were requested by 44 of 108 (40.7%) in the low- and 37 of 102 (36.3%) in the high-rate group (difference –4.4%; 95% CI of the difference, –18.5 to 9.1%; P = 0.67). Patient requested/delivered epidural bolus ratio and the hourly bupivacaine consumption were not different between groups. No subject had an adverse event.

Conclusions: Labor analgesia quality, assessed by need for provider- and patient-administered supplemental analgesia and hourly bupivacaine consumption was not improved by high-rate epidural bolus administration.