Comparison of two methods of programmed intermittent epidural bolus (PIEB) with continuous epidural injection (CEI) in labor analgesia among patients receiving epidural dexmedetomidine

Patient anesthesia using continuous epidural infusion (CEI) has been an optimal and acceptable technique for inducing epidural anesthesia for many years. This study aimed to compare two methods of programmed intermittent epidural bolus (PIEB) with continuous epidural injection (CEI) in labor analgesia among patients receiving epidural dexmedetomidine.

This study was a randomized clinical trial. The target population was term women candidates for epidural anesthesia. After selection of sample size based on inclusion criteria and a total of 3 cc of Dexmedetomidine (0.5 µg/ml) and Ropivacaine 0.1% was injected. Furthermore, 5 ml was injected as a loading dose of Dexmedetomidine 0.5 µg /ml and Ropivacaine 0.1%. Then recorded the pain score by Patient Control Epidural Analgesia tool. What were considered as the outcomes of the study included demographic information. SPSS software Version 23 was used for statistical analysis of data.

First, the neonatal Apgar score in PIEB method was more improved, and secondly, the use of assisted delivery tools such as vacuum in PIEB method was reduced. Moreover, the duration of the first phase of labor in this method was more reduced than CEI. This was while the hemodynamic conditions of the       patients in the two groups, including vital signs and arterial gar analysis, were maintained in a stable state. As a result, patients in the group undergoing epidural anesthesia by PIEB method were associated with a higher level of satisfaction with the delivery process (p < 0.05) and induction of epidural anesthesia than patients undergoing CEI protocol.

The PIEB method is associated with further improvement in neonatal (Apgar score) and maternal outcomes (reduction in the duration of the first phase of labor and no need to use assisted delivery methods) compared to the CEI protocol, but has little effect on hemodynamic conditions or drug dosage.