Comparative study of bolus (top up) bupivacaine and bupivacaine continuous epidural infusions in obstetric patients for labor analgesia
Dr. Basant Kumar Ningawal, Dr. Neha Panwar
Aims and Objectives: To compare the total bupivacaine consumption per hour of labor and the degree of motor block using the Modified Bromage score at regular intervals throughout labor.
Study Design: The study was a prospective, randomized, comparative study.
Materials and Methods: We included 50 patients, ASA physical status I, nulliparous women at term and cervical dilation < 4 cm admitted at our hospital for spontaneous labor.
Patients were divided into two groups Group A and B. Epidural analgesia was initiated with 10 ml 0.125% Bupivacaine and maintained with solution of 0.0625% Bupivacaine and Fentanyl 2 μg/ml in both groups. Group A (25 patients) received intermittent epidural bolus 10 ml every hour beginning 45 minutes after the initial dose. Group B (25 patients) received continuous infusion 10 ml/h, beginning immediately after the initial dose.
Statistical Analysis Used: Data were analysed by Unpaired ‘t’ test and 2 value applied. A value of P<0.05 was regarded as statistically significant.
Results: The median adjusted bupivacaine consumption per hour of delivery was in the first group 10.4 mg (9.4 - 12.6mg) and 8.6 mg (6.9 - 10.2mg) in the second group. There was significant difference between the two groups in the percentage of patients requesting manual bolus doses for breakthrough pain (58% intermittent epidural bolus vs 38% continuous epidural infusion) and in the need for multiple boluses (18% intermittent vs 11% continuous). Motor block was registered in only 2 patients (5.2%) in the second group (Modified Bromage 1)
Conclusion: Maintenance of epidural analgesia with continuous epidural infusion compared with intermittent epidural bolus top up decreased bupivacaine consumption without decreasing patient comfort or satisfaction.
Dr. Basant Kumar Ningawal, Dr. Neha Panwar. Comparative study of bolus (top up) bupivacaine and bupivacaine continuous epidural infusions in obstetric patients for labor analgesia. International Journal of Medicine Research, Volume 3, Issue 2, 2018, Pages 29-31