Key result
The quantity of bupivacaine used in the continuous epidural anesthesia technique was approximately 20% lower compared to the fractioned bolus technique, with transient hypotension being the most frequent complication (2.85%).
Why the study?
Does continuous epidural anesthesia compared to bolus technique reduce drug quantity and affect delivery outcomes in healthy mothers?
Observational (n=877)
No
Does continuous epidural anesthesia compared to bolus technique reduce drug quantity and affect delivery outcomes in healthy mothers?
Continuous epidural anesthesia during delivery requires about 20% less bupivacaine compared to the bolus technique, with a low rate of transient complications.
Answers are grounded in this paper and cite their sources.
Continuous epidural may reduce bupivacaine exposure in labor; leaves open effects on maternal-neonatal outcomes.
Epidural anesthesia (EA) is one of the most efficient analgesic techniques during the delivery. Its main task is to improve the quality of delivery with taking into account that the delivery is a natural process. In the dilatation phase, nerves T10-LI are responsible for the pain and, in the expulsion phase L2-S4. In application of epidural anesthesia, to enable the mother to actively participate and cooperate during the delivery, it is necessary to preserve the labour that occurs in the expulsion phase. The aim of the study was to observe the effect of epidural anesthesia to the duration and outcome of the delivery in regard with the epidural anesthesia technique applied and the dose administered in the course of the analgesia. The examination encompassed 877 mothers who have delivered under the EA in the "Narodni front" Gynecology-obstetric Clinic in Belgrade, who were healthy and did not have contraindications for EA. In the course of the year 2006, 794 pregnant women delivered by fractioned (bolus), and 83 o f them by continuous EA technique. In the bolus technique the analgesia was performed by using 0.25%, and for the continuous one 0.125% bupivacaine. The obtained results were analyzed in regard with: drug quantity administered in the first dose, doses for maintaining the analgesia, time between the first dose and cessation of the pains, time between the first dose and delivery, dilatation of the cervix in the moment of administering the first dose, number of the doses in the bolus technique, as well as the complications. Single efficient doses of bupivacaine, as well as the total quantity, given during the delivery, are far below the toxic doses. The quantity of bupivacaine in the continuous technique is about 20%> lower, relative to the bolus technique. The observed complications were of interim character, without consequences to the mother's health, and the most frequent one was hypotension.
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Tomović et al. (2007) conducted an observational in Labor and delivery (n=877). Continuous epidural anesthesia technique vs. Fractioned (bolus) epidural anesthesia technique (0.25% bupivacaine) was evaluated on Quantity of bupivacaine used. The quantity of bupivacaine used in the continuous epidural anesthesia technique was approximately 20% lower compared to the fractioned bolus technique, with transient hypotension being the most frequent complication (2.85%).
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