Abstract Background Prior studies have shown that programmed intermittent epidural bolus (PIEB) techniques, with or without patient-controlled epidural analgesia (PCEA) boluses, provide better pain relief, reduced motor block, and better patient satisfaction compared to continuous epidural infusion (CEI) techniques. We hypothesized that patients who had labor epidural analgesia (LEA) maintained with PIEB and PCEA would be less likely to receive a physician-administered rescue analgesia bolus compared to patients who had CEI and PCEA. Methods We searched our electronic medical record for patients who had CEI and PCEA from August 1, 2021 to December 31, 2021 and for patients who had PIEB and PCEA from August 2, 2022 to December 31, 2022. Results A total of 792 and 665 patients had maintenance of LEA with CEI/PCEA and PIEB/PCEA, respectively. A multivariate logistic regression was performed and, after adjusting for variables of interest, patients who had PIEB and PCEA were less likely to receive one or more physician-administered rescue analgesia boluses (odds ratio 0.504; 95% confidence interval 0.392, 0.649; P < 0.001) compared to patients who had CEI and PCEA. Conclusion PIEB/PCEA was associated with fewer physician-administered boluses of rescue analgesia compared to CEI/PCEA when used for LEA.

Effect of programmed intermittent epidural bolus protocol on physician-administered rescue boluses of labor analgesia

A standardized algorithm for assessing labor epidural analgesia

We hypothesized that implementation of a labor epidural management algorithm would increase the labor epidural catheter replacement rate at our hospital. 

Implementation of a standardized epidural top-up algorithm for inadequate labor epidural analgesia: a single-center retrospective study

Response to “a standardized algorithm for assessing labor analgesia”

Standardization of epidural top-ups for breakthrough labor pain results in a higher proportion of catheter replacements within 30 min of the first bolus dose.

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Standardization of epidural top-ups for breakthrough labor pain results in a higher proportion of catheter replacements within 30 min of the first bolus dose.