Programmed intermittent epidural bolus (PIEB) as compared to continuous epidural infusion (CEI) for the maintenance of labor analgesia: A prospective randomized single blinded controlled trial

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Korean J Anesthesiol


Background: Programmed intermittent epidural bolus (PIEB) techniques are a new area of interest for maintaining labor analgesia due to the potential to decrease motor block and improve labor analgesia. This study compares two different PIEB regimens to a continuous infusion for labor analgesia.

Methods: 150 patients undergoing scheduled induction of labor at term gestation having epidural labor analgesia were randomized to receive an epidural analgesia regimen of bupivacaine 0.125% with fentanyl 2 mcg/mL at either PIEB 5 mL every 30 min (Group 5q30), PIEB 10 mL every 60 min (Group 10q60), or 10 mL/hr continuous infusion (Group CEI). The primary outcome is pain scores throughout labor. Secondary outcomes include the number of physician administered boluses, dermatomal sensory levels, degree of motor block, and patient satisfaction.

Results: While average pain scores throughout labor did not differ significantly between groups, fewer patients in group 10q60 received physician administered boluses fo breakthrough pain (34.9% in 10q60 vs 61.0% in 5q30 and 61.9% in CEI, p = 0.022). Dermatomal sensory levels, degree of motor block, and patient satisfaction did not differ significantly between groups.

Conclusions: PIEB 10 mL every 60 minutes decreases the need for physician administered boluses as compared to PIEB 5 mL every 30 minutes or 10 mL/hr continuous infusion.

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ePub ahead of print