A randomized clinical trial to compare small frequent boluses technique with that of traditional intermittent top-ups and continuous epidural infusion, for maintenance of epidural labour analgesia

Background Prospective randomized study was designed to compare the safety and efficacy of administering small, frequent boluses of Bupivacaine and Fentanyl mixture epidurally for labour analgesia maintenance, with that of continuous infusion and traditional intermittent boluses. Methods Sixty patients having full term uncomplicated pregnancies in active labour were selected randomly after ethics committee approval. Initial block was established by injecting loading dose of 10 ml of Bupivacaine 0.125 % with Fentanyl (2 Zg/ml) mixture epidurally and maintained by 3 ml at 15 minutes interval (SFB), or 10 ml hourly as bolus (TIT) or continuous infusion 10 ml/hr (CEI). Analgesia quality, VAS, level of overall satisfaction, duration of labour, and total dose required were compared. Results Overall quality of analgesia was very good in all techniques. Difference in cumulative analgesia score percentage for 0 (No pain, pressure or tightening) was significant. Average VAS was 0.9 ± 0.87 in SFB 2.55 ± 0.91 in TIT and 0.4 ± 0.79 in CEI Group. 30 % of patients from SFB 5 % from TIT and 50 % from CEI expressed the analgesia as excellent. Total dose required and duration of labour was similar in all groups. Conclusions Our study revealed that the technique of small frequent boluses at fifteen min intervals is superior to the technique of traditional intermittent top-ups but not to the technique of continuous epidural infusion as regards quality of analgesia. Nevertheless it can be a better alternative for maintenance of epidural labour analgesia in hospitals with limited resources. Key words: epidural analgesia; labour; intermittent; top ups; infusion DOI: 10.4038/slja.v18i2.1778 Sri Lankan Journal of Anaesthesiology 18(2): 75-80 (2010)