Programmed Intermittent Epidural Bolus (PIEB) Techniques for Labour Analgesia
Epidural Analgesia remains the most effective form of pain relief in labour. After initiating epidural analgesia, there are many epidural drug regimens that can be employed to maintain analgesia for the duration of labour using an epidural catheter. Due to recent advances in medical technology, new epidural pumps, which allow both patient controlled epidural analgesia boluses (PCEA, a common standard of care in many hospitals) and programmed intermittent epidural boluses (PIEB, automatic boluses given in addition to the PCEA bolus), are now available. In this randomized double-blind trial, we aim to evaluate the effects of different combinations of PIEB (epidural bolus volume) and PIEB (bolus volume and time interval) on labour patient-controlled epidural analgesia (PCEA) usage. In theory, the more effective the PIEB combination (the ideal drug volume and ideal time interval), the less PCEA boluses (extra epidural drug) will be used as well as less clinician boluses and less lower limb weakness (motor block) as assessed by the Bromage Score.
- EligibilityCriteria: Inclusion Criteria:  Age 18 to 50 yrs In active labour ASA 2 patients (pregnant patients are considered to be ASA 2) Singleton pregnancy > 37 weeks gestation Booking BMI 18 to 35  Exclusion Criteria:  BMI < 18 BMI > 35 Systemic opioids within the previous 6 hours Presence of a fetal anomaly Pre-eclampsia Bleeding disorders (including coagulation disorders) Recent spinal surgery Spinal injury Elevated intracranial pressure (ICP) Neuraxial disorders of any description Signs of local or systemic infection Patient refusal for neuraxial analgesia - HealthyVolunteers: No - Gender: Female - GenderBased: Yes - GenderDescription: parturient 37+ weeks - MinimumAge: 18 Years - MaximumAge: 50 Years - StdAgeList: Adult