Comparison of labor analgesia efficacy between single-orifice and multiorifice wire-reinforced catheters during programmed intermittent epidural boluses: a randomized controlled clinical trial. Issue 2 (9th November 2022)

• Record Type: Journal Article
• Authors: Yi, Juan; Li, Yujie; Yuan, Yawei; Xu, Zhendong; Song, Yujie; Ye, Binglu; Zhao, Qingsong; Yang, Yingying; Du, Weijia; Liu, Zhiqiang
• Is Part Of: Regional anesthesia and pain medicine. Volume 48:Issue 2(2023)
• Page Start: 61
• Page End: 66
• Publication Date: 2022-11-09
• Subjects: Obstetrics -- Pain Management -- analgesia; Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1136/rapm-2022-103723
• Languages: English
• ISSNs: 1098-7339

Abstract

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.