Programmed Intermittent Epidural Bolus for Labor Analgesia During First Stage of Labor 2
Status:
Completed
Trial end date:
2017-02-01
Target enrollment:
Participant gender:
Summary
Brief 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
investigators are currently using pumps set up with PIEB, in addition to what the patient can
deliver herself (PCEA). Studies have shown that delivering analgesia in this manner prolong
the duration of analgesia, reduce motor block, lower the incidence of breakthrough pain,
improve maternal satisfaction and decrease local anesthetic consumption. The investigators
have recently concluded a study at MSH using PIEB where they observed excellent results.
However, some patients exhibited higher than necessary sensory blocks. The investigators
believe that the technique can be optimized by using the same dose of the freezing
medication, but using a smaller volume of local anesthetic at a higher concentration. This
optimization may also further reduce the amount of medication used by each patient.
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 5 ml of bupivacaine 0.125% with fentanyl 2mcg/ml
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