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Comparison of labor analgesia efficacy between single-orifice and multiorifice wire-reinforced catheters during programmed intermittent epidural boluses: a randomized controlled clinical trial
  1. Juan Yi1,2,
  2. Yujie Li1,
  3. Yawei Yuan1,
  4. Zhendong Xu1,
  5. Yujie Song1,
  6. Binglu Ye1,
  7. Qingsong Zhao1,
  8. Yingying Yang3,
  9. Weijia Du1 and
  10. Zhiqiang Liu1
  1. 1Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
  2. 2Department of Anesthesiology, Ningbo First Hospital, Ningbo, China
  3. 3Clinical Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
  1. Correspondence to Dr Weijia Du, Tongji University School of Medicine, Shanghai 200092, Shanghai 200092, China; duweijia{at}51mch.com; Dr Zhiqiang Liu, Tongji University School of Medicine, Shanghai 200092, China; drliuzhiqiang{at}163.com

Abstract

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.

  • Obstetrics
  • Pain Management
  • analgesia

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Footnotes

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.