Programmed Intermittent Epidural Bolus Versus Continuous Infusion in Labour Analgesia

NCT ID: NCT03730753

Last Updated: 2023-11-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-06-01

Study Completion Date

2025-06-30

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Labor Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Control group

Continuous infusion + patient controlled epidural analgesia

Group Type ACTIVE_COMPARATOR

Continuous infusion

Intervention Type DEVICE

Continuous infusion added to patient controlled epidural analgesia

Study group

Programmed intermittent epidural bolus + patient controlled analgesia

Group Type EXPERIMENTAL

Programmed intermittent epidural bolus

Intervention Type DEVICE

Programmed intermittent epidural bolus added to patient controlled epidural analgesia

Interventions

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Programmed intermittent epidural bolus

Programmed intermittent epidural bolus added to patient controlled epidural analgesia

Intervention Type DEVICE

Continuous infusion

Continuous infusion added to patient controlled epidural analgesia

Intervention Type DEVICE

Eligibility Criteria

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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
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Université de Sherbrooke

OTHER

Sponsor Role lead

Responsible Party

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Geneviève Rivard

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Geneviève Rivard, Dr.

Role: PRINCIPAL_INVESTIGATOR

Université de Sherbrooke

Locations

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CHUS

Sherbrooke, Quebec, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Isabelle Caron, Dr.

Role: CONTACT

Phone: +1 819 346-1110

Email: [email protected]

Geneviève Rivard, Dr.

Role: CONTACT

Phone: +1 819 346-1110

Email: [email protected]

Facility Contacts

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Genevieve Rivard, FRCPC

Role: primary

Isabelle Caron

Role: backup

References

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Liu EH, Sia AT. Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review. BMJ. 2004 Jun 12;328(7453):1410. doi: 10.1136/bmj.38097.590810.7C. Epub 2004 May 28.

Reference Type BACKGROUND
PMID: 15169744 (View on PubMed)

Nunes J, Nunes S, Veiga M, Cortez M, Seifert I. A prospective, randomized, blinded-endpoint, controlled study - continuous epidural infusion versus programmed intermittent epidural bolus in labor analgesia. Braz J Anesthesiol. 2016 Sep-Oct;66(5):439-44. doi: 10.1016/j.bjane.2014.12.006. Epub 2015 Nov 19.

Reference Type BACKGROUND
PMID: 27591455 (View on PubMed)

Salim R, Nachum Z, Moscovici R, Lavee M, Shalev E. Continuous compared with intermittent epidural infusion on progress of labor and patient satisfaction. Obstet Gynecol. 2005 Aug;106(2):301-6. doi: 10.1097/01.AOG.0000171109.53832.8d.

Reference Type BACKGROUND
PMID: 16055579 (View on PubMed)

Chua SM, Sia AT. Automated intermittent epidural boluses improve analgesia induced by intrathecal fentanyl during labour. Can J Anaesth. 2004 Jun-Jul;51(6):581-5. doi: 10.1007/BF03018402.

Reference Type BACKGROUND
PMID: 15197122 (View on PubMed)

Lim Y, Sia AT, Ocampo C. Automated regular boluses for epidural analgesia: a comparison with continuous infusion. Int J Obstet Anesth. 2005 Oct;14(4):305-9. doi: 10.1016/j.ijoa.2005.05.004.

Reference Type BACKGROUND
PMID: 16154735 (View on PubMed)

Lim Y, Chakravarty S, Ocampo CE, Sia AT. Comparison of automated intermittent low volume bolus with continuous infusion for labour epidural analgesia. Anaesth Intensive Care. 2010 Sep;38(5):894-9. doi: 10.1177/0310057X1003800514.

Reference Type BACKGROUND
PMID: 20865875 (View on PubMed)

Fettes PD, Moore CS, Whiteside JB, McLeod GA, Wildsmith JA. Intermittent vs continuous administration of epidural ropivacaine with fentanyl for analgesia during labour. Br J Anaesth. 2006 Sep;97(3):359-64. doi: 10.1093/bja/ael157. Epub 2006 Jul 18.

Reference Type BACKGROUND
PMID: 16849382 (View on PubMed)

Wong CA, Ratliff JT, Sullivan JT, Scavone BM, Toledo P, McCarthy RJ. A randomized comparison of programmed intermittent epidural bolus with continuous epidural infusion for labor analgesia. Anesth Analg. 2006 Mar;102(3):904-9. doi: 10.1213/01.ane.0000197778.57615.1a.

Reference Type BACKGROUND
PMID: 16492849 (View on PubMed)

Leo S, Ocampo CE, Lim Y, Sia AT. A randomized comparison of automated intermittent mandatory boluses with a basal infusion in combination with patient-controlled epidural analgesia for labor and delivery. Int J Obstet Anesth. 2010 Oct;19(4):357-64. doi: 10.1016/j.ijoa.2010.07.006. Epub 2010 Sep 15.

Reference Type BACKGROUND
PMID: 20832282 (View on PubMed)

Tien M, Allen TK, Mauritz A, Habib AS. A retrospective comparison of programmed intermittent epidural bolus with continuous epidural infusion for maintenance of labor analgesia. Curr Med Res Opin. 2016 Aug;32(8):1435-40. doi: 10.1080/03007995.2016.1181619. Epub 2016 May 20.

Reference Type BACKGROUND
PMID: 27100210 (View on PubMed)

Sia AT, Lim Y, Ocampo C. A comparison of a basal infusion with automated mandatory boluses in parturient-controlled epidural analgesia during labor. Anesth Analg. 2007 Mar;104(3):673-8. doi: 10.1213/01.ane.0000253236.89376.60.

Reference Type BACKGROUND
PMID: 17312228 (View on PubMed)

Capogna G, Camorcia M, Stirparo S, Farcomeni A. Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia: the effects on maternal motor function and labor outcome. A randomized double-blind study in nulliparous women. Anesth Analg. 2011 Oct;113(4):826-31. doi: 10.1213/ANE.0b013e31822827b8. Epub 2011 Jul 25.

Reference Type BACKGROUND
PMID: 21788309 (View on PubMed)

McKenzie CP, Cobb B, Riley ET, Carvalho B. Programmed intermittent epidural boluses for maintenance of labor analgesia: an impact study. Int J Obstet Anesth. 2016 May;26:32-8. doi: 10.1016/j.ijoa.2015.11.005. Epub 2015 Nov 27.

Reference Type BACKGROUND
PMID: 26775896 (View on PubMed)

Epsztein Kanczuk M, Barrett NM, Arzola C, Downey K, Ye XY, Carvalho JC. Programmed Intermittent Epidural Bolus for Labor Analgesia During First Stage of Labor: A Biased-Coin Up-and-Down Sequential Allocation Trial to Determine the Optimum Interval Time Between Boluses of a Fixed Volume of 10 mL of Bupivacaine 0.0625% With Fentanyl 2 mug/mL. Anesth Analg. 2017 Feb;124(2):537-541. doi: 10.1213/ANE.0000000000001655.

Reference Type BACKGROUND
PMID: 27755057 (View on PubMed)

Wong CA, McCarthy RJ, Hewlett B. The effect of manipulation of the programmed intermittent bolus time interval and injection volume on total drug use for labor epidural analgesia: a randomized controlled trial. Anesth Analg. 2011 Apr;112(4):904-11. doi: 10.1213/ANE.0b013e31820e7c2f.

Reference Type BACKGROUND
PMID: 21430035 (View on PubMed)

George RB, Allen TK, Habib AS. Intermittent epidural bolus compared with continuous epidural infusions for labor analgesia: a systematic review and meta-analysis. Anesth Analg. 2013 Jan;116(1):133-44. doi: 10.1213/ANE.0b013e3182713b26. Epub 2012 Dec 7.

Reference Type BACKGROUND
PMID: 23223119 (View on PubMed)

Lee L, Dy J, Azzam H. Management of Spontaneous Labour at Term in Healthy Women. J Obstet Gynaecol Can. 2016 Sep;38(9):843-865. doi: 10.1016/j.jogc.2016.04.093. Epub 2016 Jun 25.

Reference Type BACKGROUND
PMID: 27670710 (View on PubMed)

Todd KH, Funk JP. The minimum clinically important difference in physician-assigned visual analog pain scores. Acad Emerg Med. 1996 Feb;3(2):142-6. doi: 10.1111/j.1553-2712.1996.tb03402.x.

Reference Type BACKGROUND
PMID: 8808375 (View on PubMed)

Singer AJ, Thode HC Jr. Determination of the minimal clinically significant difference on a patient visual analog satisfaction scale. Acad Emerg Med. 1998 Oct;5(10):1007-11. doi: 10.1111/j.1553-2712.1998.tb02781.x.

Reference Type BACKGROUND
PMID: 9862594 (View on PubMed)

Other Identifiers

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2018 - 2686

Identifier Type: -

Identifier Source: org_study_id