Aims We compared analgesic outcomes between single-orifice and multiorifice wire-reinforced catheters under 480 mL/hour delivery rate with programmed intermittent epidural bolus administration.
Methods Between August and November 2021, 182 nulliparous and healthy women with singleton pregnancy, 2–5 cm cervical dilation, and requesting neuraxial analgesia were randomized to receive either single-orifice or multiorifice catheters. Epidural analgesia was initiated and maintained with 0.1% ropivacaine and 0.3 µg/mL sufentanil. Programmed intermittent epidural bolus volume of 10 mL was administered every 45 min at 480 mL/hour beginning immediately after the test dose. Primary outcome was the percentage of parturients in the two groups with adequate analgesia 20 min after the initial bolus.
Results Compared with multiorifice catheters, single-orifice catheters were associated with a higher proportion of parturients with adequate analgesia (71.8% vs 56.0%, respectively; 95% CI 1.3% to 29%, p=0.03) and more frequent S2 sensory blockade (37.6% vs 22.6%, respectively; 95% CI −30% to 1%, p=0.03) 20 min after block initiation. Median time (IQR) to adequate analgesia was 12 (8–30) min and 20 (10–47) min with single-orifice and multiorifice catheters, respectively (95% CI 0.1 to 0.7 min, p<0.01). The median (IQR) ropivacaine consumption per hour was higher in parturients receiving multiorifice catheters than those with single-orifice catheters (15.3 (13.3–17.0) mg/hour vs 13.3 (13.3–15.4) mg/hour, respectively; 95% CI 0.2 to 0.8 mg/hour, p<0.001).
Conclusion Single-orifice catheters used for programmed intermittent epidural bolus at 480 mL/hour for epidural labor analgesia had improved analgesic efficacy than multiorifice catheters.
Trial registration number ChiCTR2100049872.
- Pain Management
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
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JY, YL and YY are joint first authors.
WD and ZL contributed equally.
Contributors JY, WD, and YL participated in the design, conducted the study, analyzed the data, and prepared the manuscript. YY participated in the design, conducted the study, analyzed the data, and prepared the manuscript. YL participated in collecting and analyzing the data and contributed to the preparation of the manuscript. BY participated in collecting and analyzing the data and contributed to the preparation of the manuscript. YS participated in collecting and analyzing the data and contributed to the preparation of the manuscript. ZX and YY participated in collecting and analyzing the data and contributed to the preparation of the manuscript. ZX led the design and supervised the performance of the study, participated in data analysis, and participated in the preparation of the manuscript. ZL led the design and oversaw the performance of the study, reviewed and analyzed the data, and supervised the preparation of the manuscript. WD accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding This work was supported in part by the grants of Pudong Health Committee of Shanghai (PW2021D-01) and Clinical Research Plan of SHDC (SHDC22020205), Science and Technology Commission of Shanghai Municipality (19401930500, 22Y11905900), and Research Fund of Shanghai Association of Chinese Integrative Medicine.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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