High-volume patient-controlled epidural vs. programmed intermittent epidural bolus for labour analgesia: a randomised controlled study

Neuraxial labour analgesia is a safe and effective method of pain relief. Following initiation of analgesia with epidural or combined spinal-epidural, this can be maintained with continuous epidural infusion, manual intermittent boluses, patient-controlled epidural analgesia (PCEA), programmed intermittent epidural bolus (PIEB) or a combination of these.

This new RCT finds that a PCEA high-volume bolus without a background infusion is not inferior to PIEB for maintenance of epidural labour analgesia and superior regarding local anaesthetic consumption. The results of the study support the use of high-volume bolus techniques, whether as part of PIEB or PCEA, for the maintenance of epidural labour analgesia. The PIEB techniques provide more consistent pain control (less variability), whereas PCEA-only may give women more control over their analgesia.

For this podcast, Dr Louise Savic discussed the methods and resultant implications with the authors.