Overview
The purpose of this randomized controlled trial is to compare the efficacy and safety of two epidural analgesia maintenance methods for labor pain relief: Programmed Intermittent Epidural Bolus (PIEB) and Continuous Epidural Infusion (CEI), both combined with Patient-Controlled Epidural Analgesia (PCEA). The study aims to evaluate which technique provides superior analgesia while minimizing anesthetic consumption and preserving maternal motor function. A total of 60 parturients at Family Hospital, Da Nang, will be randomly assigned to either the PIEB or CEI group. Outcomes including pain intensity (VAS scores), total drug consumption, maternal satisfaction, and neonatal Apgar scores will be assessed.
Description
This study is a prospective, randomized controlled trial conducted at the Labor and Delivery Unit of Family Hospital, Da Nang. The investigation focuses on the clinical advantages of automated high-pressure bolus delivery (PIEB) compared to constant low-pressure flow (CEI) in optimizing the spread of local anesthetics within the epidural space.
Clinical Procedures: All participants receive a standardized initial manual bolus of 10 mL (0.1% Ropivacaine and 2 mcg/mL Fentanyl) to establish a baseline sensory block. Following this induction, patients are managed according to their assigned study arm:
PIEB Group: Analgesia is maintained using a programmed pump set to deliver an automated bolus of 8 mL every 60 minutes, starting one hour after the initial dose.
CEI Group: Analgesia is maintained via a continuous infusion of the same anesthetic solution at a constant rate of 8 mL/hour.
Analgesia Management and Rescue Protocol: Both groups have access to PCEA, allowing for self-administered 5 mL boluses with a 10-minute lockout period, capped at a maximum of 20 mL per hour.
To ensure maternal comfort, a standardized rescue protocol is strictly followed: if the Visual Analog Scale (VAS) score remains \> 4 after two consecutive PCEA demands, a manual rescue bolus of 5 mL is administered by the anesthesia team.
Eligibility
Inclusion Criteria:
- Parturients indicated for labor analgesia for vaginal delivery via epidural anesthesia.
- Age from 18 to 40 years.
- Physical status: ASA II.
- Singleton pregnancy, full-term, vertex presentation in labor.
- Indication for vaginal delivery.
- No contraindications to epidural anesthesia.
- Agreement to participate in the research and signed written informed consent.
Exclusion Criteria:
- Contraindications to epidural analgesia.
- History of allergy to local anesthetics (Ropivacaine) or opioids (Fentanyl).
- High-risk pregnancies: Preeclampsia, placenta previa, placental abruption.
- Fetal distress or fetal abnormalities.
- Chronic use of analgesic drugs or neurological/psychiatric disorders.
- Parturients who refuse to participate or request to withdraw from the research.
