Article Text

Download PDFPDF

B5 High-volume PCEA versus PIEB for labour analgesia: a randomised, double-blind, two-center, non-inferiority study in nulliparous women investigating quality of pain relief
  1. N Filetici1,
  2. E Roofthooft2,
  3. S Rex3,
  4. CA Wong4 and
  5. M Van de Velde3
  1. 1Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  2. 2Dept. Anesthesiology, GZA Ziekenhuizen, Antwerp, Belgium
  3. 3Dept. Anesthesiology, UZ Leuven, Leuven, Belgium
  4. 4Dept. Anesthesia, University of Iowa, Iowa City, USA


Background and Aims Maintenance of neuraxial labour analgesia using programmed intermittent epidural boluses (PIEB) is superior compared to continuous epidural infusions with/without patient controlled epidural analgesia (PCEA), causing less breakthrough pain, motor block and local anesthetic (LA) consumption1. Compared to low-volume PCEA without background infusion, PIEB produces less breakthrough pain and motor block, despite higher LA consumption.

The goal of this randomised, double-blind, non-inferiority study was to investigate if high-volume PCEA without background infusion compared to PIEB+PCEA, set with equal boluses, results in a similar incidence of breakthrough pain and LA consumption.

Methods Following ethics approval and written consent, combined spinal-epidural for labour was performed in 360 nulliparous women. Analgesia was maintained with ropivacaine 0.12% and sufentanil 0.75mcg/mL. Patients randomly received high-volume PCEA without background infusion set at 10 mL bolus with a 30 min lock-out or PIEB as 10 mL bolus every hour plus PCEA boluses of 5 mL with a 30 min lock-out. Breakthrough pain, motor block and LA consumption were recorded.

Results Final analysis was performed in 336 women (PCEA n=170; PIEB-PCEA n=166). Breakthrough pain occurred in 11.2% in the PCEA-group and 10.8% in the PIEB-group. Total LA consumption was lower in the PCEA-group than in the PIEB-group (mean 53.1 versus 65.2 mL respectively, p< 0.0001). Motor block was not different between groups (p=0.783).

Conclusions High-volume PCEA without background infusion and PIEB showed a similar incidence of breakthrough pain and motor block. The PCEA-group had a lower total LA consumption.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.