Influence of different volumes and frequency of programmed intermittent epidural bolus in labor on maternal and neonatal outcomes: A systematic review and network meta-analysis
Study context
- Population
- Pregnant patients in labor receiving continuous epidural infusion (CEI) or programmed intermittent epidural bolus (PIEB) with or without patient controlled epidural analgesia (PCEA)30 trials
- Comparison
- PIEB regimens of different volumes and dosing intervals vs each other and vs CEI
- Outcome
- Need for rescue analgesia; maternal satisfaction (multiple primary endpoints)
Methodological detailsfrequentist network meta-analysis, Cochrane risk of bias 2 tool, Risk of bias: some concerns in two thirds of trials, high in the remaining one third
- Frequentist network meta-analysis
- Cochrane risk of bias 2 tool
- Risk of bias: some concerns in two thirds of trials, high in the remaining one third
Pooled result
As reported in the abstract
Need for rescue analgesia; maternal satisfaction
Odds ratio (95% CI)
PIEB 4/45 vs PIEB 8/45need for rescue analgesia; inferior
3.55(1.12–11.33)
PIEB 10/60 vs PIEB 2.5/15need for rescue analgesia; superior
0.36(0.16–0.82)
PIEB 10/60 vs PIEB 4/45need for rescue analgesia; superior
0.14(0.03–0.71)
PIEB 10/60 vs PIEB 5/60need for rescue analgesia; superior
0.23(0.08–0.70)
PIEB 5/30 vs PIEB 10/60need for rescue analgesia; not inferior
0.61(0.31–1.19)
Further pooled results
| Outcome | MD (95% CI) | |
|---|---|---|
| Pain score · 4 hPIEB 5/30 vs PIEB 2.5/15 | 2.45 (0.13–4.76) | |
| Pain score · 4 hPIEB 5/30 vs PIEB 5/60 | −2.28 (−4.18--0.38) | |
| Pain score · 4 hPIEB 5/30 vs PIEB 10/60 | 1.73 (0.31–3.16) | |
| −6−4−20246Difference (linear scale) |
Pain score · 4 h
- PIEB 5/30 decreased the pain score vs PIEB 2.5/15, 5/60 and 10/60
Cumulative local anesthetic dose (mean ranking)
- PIEB 10/60 followed by PIEB 5/30 best placed to reduce cumulative local anesthetic dose
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Lower limb motor blockadePIEB 10/60 vs CEI | 0.30 (0.14–0.67) | |
| 0.10.31310Odds ratio (log scale) |
Neonatal outcomes
- No differences in neonatal outcomes
Original publication
Influence of different volumes and frequency of programmed intermittent epidural bolus in labor on maternal and neonatal outcomes: A systematic review and network meta-analysis. J Clin Anesth. Published 4 January 2024. doi:10.
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