Programmed Intermittent Epidural Bolus Versus Continuous Infusion in Labour Analgesia

Programmed Intermittent Epidural Bolus Versus Continuous Infusion When Added to Patient-controlled Epidural Analgesia on Bupivacaine Consumption in Labour Analgesia: a Randomized Controlled Trial

This study aims to establish if programmed intermittent epidural bolus combined to patient controlled analgesia in labour analgesia will lower the hourly bupivacaine consumption when compared to continuous infusion combined with patient controlled analgesia. The investigators' hypothesis is that the use of programmed intermittent epidural bolus will lower the hourly bupivacaine consumption.

Patients are randomised to receive either a programmed bolus of 6ml each 45 minutes or a continuous infusion of 8ml/h. In each group, they have the possibility to add a PCEA bolus of 6ml every 20min as needed.

Inclusion Criteria:

• Pregnant nulliparous or multiparous woman in labour
• Age ≥18 years
• Obtained consent for epidural analgesia
• ASA classification I-II-III
• Early labour (cervical dilation ≤6cm)

Exclusion Criteria:

• Pregnancy-related comorbidities (preeclampsia, eclampsia, gestational diabetes, large for gestational age fetus)
• Prematurity (<36 weeks of gestation)
• Multiple gestation
• Fentanyl allergy or hypersensitivity
• Patient unable to understand the PCEA
• Fetal breech position
• Maternal cardiac pathology and contraindication to Valsalva manoeuvre
• Patient with a pain visual analog scale (VAS) not ≤1/10 20 minutes after the anesthesiologist's initial bolus
• Intrathecal catheter or intravascular catheter
• Accidental dural puncture
• Patient refusal
• Patient with a history of chronic pain (pain lasting more than 3 months) or fibromyalgia