Epidural bolus requirements

Published Date: 19th July 2016

Publication Authors: Yoxall PF

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Introduction

In our department, we use both continuous infusion and programmed intermittent bolus techniques for labour epidural management. As a service evaluation project, we decided to assess the number of additional boluses which were required with each of these techniques.

Methods

We retrospectively examined the clinical records of 97 women who had received labour epidurals. All women received epidural infusions of 0.1% levobupivacaine + 2 μg/mL fentanyl either as a continuous infusion, between 10-15mL/h, or as a programmed intermittent bolus regime (PIB) giving 8 mL/h plus a 5 mL bolus every hour. Midwives could give further boluses of 10 mL from the pump every 30 min, the anaesthetist could give rescue boluses of whatever they felt appropriate. We recorded the number of the two types of boluses that were administered and the highest level of sensory block documented.

Results

Forty-nine women had a continuous infusion and 48 a PIB epidural. There was no significant difference in required boluses between the two regimes (MLBs P=0.133, ALBs P=0.72). The highest recorded sensory block in the continuous infusion group had a range from T12-T3 (median T6), and in the PIB group T11 -T5 (median T8). The sensory block was significantly higher in the continuous infusion group (P=0.002).

Discussion

Studies suggest the use of PIB epidurals can reduce manual bolus requirements. In addition, there may be reduced local anaesthetic usage and improved maternal satisfaction. This evaluation has given us information about our current requirements for manual boluses and therefore the workload impact on both midwifery and anaesthetic staff. The requirement for anaesthetist led rescue boluses was reassuringly low at <15% . We did not show a significantly lower requirement for boluses in our PIB group to support recent studies. However, further work with greater patient numbers may show more difference between the groups.

Wrigley, HK; Yoxall, P. (2014).  A service evaluation to assess epidural bolus requirements . International Journal of Obstetric Anesthesia,. 23 (Suppl 1), S51.

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