Programmed Intermittent Epidural Bolus for Labor Analgesia During First Stage of Labor
Status:
Completed
Trial end date:
2015-12-01
Target enrollment:
Participant gender:
Summary
Until recently, at Mount Sinai Hospital, epidural analgesia for labor pain was delivered with
a pump that could only provide continuous infusion of the freezing medication in combination
of pushes of medication activated by the patient, a technique called patient controlled
epidural analgesia (PCEA). In the last decade or so, the literature has suggested that this
continuous infusion of medication is not as effective as previously thought, and suggested
that instead of continuous infusion, intermittent programmed pushes should be used. The
investigators now have devices that are able to do that. Programmed intermittent epidural
bolus (PIEB) is a new technological advance based on the concept that boluses of freezing
medication in the epidural space are superior to continuous epidural infusion (CEI). The new
pumps are able to deliver bolus of medication at regular intervals (PIEB), in addition to
what the patient can deliver herself (PCEA). Studies have shown that delivering analgesia in
this manner can prolong the duration of analgesia, diminish motor block, lower the incidence
of breakthrough pain, improve maternal satisfaction and decrease local anesthetic
consumption. Based on the information already available in the literature, this study aims to
determine the best regimen of PIEB achievable with our standard epidural mixture.
The hypothesis of this study is that there is an optimal interval time between PIEB boluses
of 30 to 60 minutes at a fixed volume of 10 ml of our standard epidural mixture that will
provide women the necessary drug requirements, thus avoiding breakthrough pain and need for
PCEA or physician intervention.
Phase:
N/A
Details
Lead Sponsor:
Samuel Lunenfeld Research Institute, Mount Sinai Hospital