Comparison of different bolus delivery speeds of a programmed intermittent epidural bolus combined with dural puncture epidural block during labour analgesia

BACKGROUND Dural puncture epidural block (DPE) with programmed intermittent epidural bolus (PIEB) delivery provides effective analgesia for labour pain; however, it poses a risk of a high level of block. OBJECTIVE To investigate the effect different pump speeds for a PIEB on maternal sensory block after DPE. DESIGN A prospective, double-blind, randomised controlled study. SETTING An Obstetrics and Gynaecology Hospital, China, from June 2023 to December 2023. PARTICIPANTS Labour analgesia was administered to 120 nulliparous women with a singleton pregnancy during the first stage of labour. INTERVENTION After DPE insertion, women using labour analgesia were randomly allocated into a low-speed group (120 ml h −1 ), a medium-speed group (240 ml h −1 ) or a high-speed group (360 ml h −1 ). Epidural catheters were placed at L3/4 or L4/5, and epidural analgesia was maintained with a PIEB; 10 ml every 60 min using 0.1% ropivacaine with 0.3 μg ml −1 sufentanil. MAIN OUTCOME MEASURE The primary outcome was the highest level of upper sensory block from administering DPE combined with PIEB until delivery. RESULTS A total of 143 parturients were approached and 120 were randomised to three groups of 40. There were no statistically significant differences between the three groups at any time in either the highest sensory block ( P = 0.14) or the upper sensory block ( P = 0.27). Lower sensory ( P = 0.20) and sacral blocks ( P = 0.84) did not differ between groups. Nevertheless, the highest visual analogue pain scores (> 3) after labour anaesthesia was statistically different between the three groups ( P = 0.023). Satisfaction with labour analgesia was significantly different between groups ( P = 0.006). No differences in other secondary outcomes were noted. CONCLUSION DPE with PIEB delivery of 360 ml h −1 did not produce higher sensory block levels than either 240 ml h −1 or 120 ml h −1 . However, in secondary outcomes, the high speed delivery did provide more effective labour analgesia and higher satisfaction than low speed delivery.