Cargando…
A Meta-Analysis of Comparing Intermittent Epidural Boluses and Continuous Epidural Infusion for Labor Analgesia
With the development of medical equipment and techniques in labor anesthesia, it is a major issue to investigate the risks and treatment effects among techniques such as continuous epidural infusion (CEI) and intermittent epidural bolus (IEB). However, there is a controversial result regarding two t...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579642/ https://www.ncbi.nlm.nih.gov/pubmed/32992642 http://dx.doi.org/10.3390/ijerph17197082 |
_version_ | 1783598637852393472 |
---|---|
author | Tzeng, I-Shiang Kao, Ming-Chang Pan, Po-Ting Chen, Chu-Ting Lin, Han-Yu Hsieh, Po-Chun Kuo, Chan-Yen Hsieh, Tsung-Han Kung, Woon-Man Cheng, Chu-Hsuan Chen, Kuo-Hu |
author_facet | Tzeng, I-Shiang Kao, Ming-Chang Pan, Po-Ting Chen, Chu-Ting Lin, Han-Yu Hsieh, Po-Chun Kuo, Chan-Yen Hsieh, Tsung-Han Kung, Woon-Man Cheng, Chu-Hsuan Chen, Kuo-Hu |
author_sort | Tzeng, I-Shiang |
collection | PubMed |
description | With the development of medical equipment and techniques in labor anesthesia, it is a major issue to investigate the risks and treatment effects among techniques such as continuous epidural infusion (CEI) and intermittent epidural bolus (IEB). However, there is a controversial result regarding two techniques. This study was conducted through meta-analysis of randomized controlled trials (RCTs) for labor analgesia between the CEI and IEB techniques. The pooled results were presented as weighted mean differences (WMDs) together with 95% confidence intervals (CIs) and odds ratios (ORs) together with 95% CIs, respectively. Eleven RCTs were included in this meta-analysis. Four hundred sixty-five parturients accepted CEI, whereas 473 parturients accepted IEB labor analgesia. Elven identified low- risk bias studies were recruited for meta-analysis. The results presented no statistical difference in cesarean delivery rate between IEB and CEI (OR, 0.96; 95% CI, 0.67–1.37) and duration of second stage of labor (WMD, −3.82 min; 95% CI, −8.28 to 0.64). IEB had statistically significant lessened risk of instrumental delivery (OR, 0.59; 95% CI, 0.39–0.90) and for the use in local anesthetic (WMD, −1.71 mg bupivacaine equivalents per hour; 95% CI, −1.88 and −1.55). Accepted IEB had a higher score of maternal satisfaction (WMD, −6.95 mm; 95% CI, −7.77 to −6.13). Based on evidence, IEB showed a greater benefit for slightly reducing the use in local anesthetic, reduced risk of instrumental delivery, and improved maternal satisfaction for the requirement of labor epidural analgesia for healthy women. In the future, more studies need to be conducted to practice the IEB regimen and explore its influence on labor analgesia. |
format | Online Article Text |
id | pubmed-7579642 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-75796422020-10-29 A Meta-Analysis of Comparing Intermittent Epidural Boluses and Continuous Epidural Infusion for Labor Analgesia Tzeng, I-Shiang Kao, Ming-Chang Pan, Po-Ting Chen, Chu-Ting Lin, Han-Yu Hsieh, Po-Chun Kuo, Chan-Yen Hsieh, Tsung-Han Kung, Woon-Man Cheng, Chu-Hsuan Chen, Kuo-Hu Int J Environ Res Public Health Article With the development of medical equipment and techniques in labor anesthesia, it is a major issue to investigate the risks and treatment effects among techniques such as continuous epidural infusion (CEI) and intermittent epidural bolus (IEB). However, there is a controversial result regarding two techniques. This study was conducted through meta-analysis of randomized controlled trials (RCTs) for labor analgesia between the CEI and IEB techniques. The pooled results were presented as weighted mean differences (WMDs) together with 95% confidence intervals (CIs) and odds ratios (ORs) together with 95% CIs, respectively. Eleven RCTs were included in this meta-analysis. Four hundred sixty-five parturients accepted CEI, whereas 473 parturients accepted IEB labor analgesia. Elven identified low- risk bias studies were recruited for meta-analysis. The results presented no statistical difference in cesarean delivery rate between IEB and CEI (OR, 0.96; 95% CI, 0.67–1.37) and duration of second stage of labor (WMD, −3.82 min; 95% CI, −8.28 to 0.64). IEB had statistically significant lessened risk of instrumental delivery (OR, 0.59; 95% CI, 0.39–0.90) and for the use in local anesthetic (WMD, −1.71 mg bupivacaine equivalents per hour; 95% CI, −1.88 and −1.55). Accepted IEB had a higher score of maternal satisfaction (WMD, −6.95 mm; 95% CI, −7.77 to −6.13). Based on evidence, IEB showed a greater benefit for slightly reducing the use in local anesthetic, reduced risk of instrumental delivery, and improved maternal satisfaction for the requirement of labor epidural analgesia for healthy women. In the future, more studies need to be conducted to practice the IEB regimen and explore its influence on labor analgesia. MDPI 2020-09-27 2020-10 /pmc/articles/PMC7579642/ /pubmed/32992642 http://dx.doi.org/10.3390/ijerph17197082 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Tzeng, I-Shiang Kao, Ming-Chang Pan, Po-Ting Chen, Chu-Ting Lin, Han-Yu Hsieh, Po-Chun Kuo, Chan-Yen Hsieh, Tsung-Han Kung, Woon-Man Cheng, Chu-Hsuan Chen, Kuo-Hu A Meta-Analysis of Comparing Intermittent Epidural Boluses and Continuous Epidural Infusion for Labor Analgesia |
title | A Meta-Analysis of Comparing Intermittent Epidural Boluses and Continuous Epidural Infusion for Labor Analgesia |
title_full | A Meta-Analysis of Comparing Intermittent Epidural Boluses and Continuous Epidural Infusion for Labor Analgesia |
title_fullStr | A Meta-Analysis of Comparing Intermittent Epidural Boluses and Continuous Epidural Infusion for Labor Analgesia |
title_full_unstemmed | A Meta-Analysis of Comparing Intermittent Epidural Boluses and Continuous Epidural Infusion for Labor Analgesia |
title_short | A Meta-Analysis of Comparing Intermittent Epidural Boluses and Continuous Epidural Infusion for Labor Analgesia |
title_sort | meta-analysis of comparing intermittent epidural boluses and continuous epidural infusion for labor analgesia |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579642/ https://www.ncbi.nlm.nih.gov/pubmed/32992642 http://dx.doi.org/10.3390/ijerph17197082 |
work_keys_str_mv | AT tzengishiang ametaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT kaomingchang ametaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT panpoting ametaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT chenchuting ametaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT linhanyu ametaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT hsiehpochun ametaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT kuochanyen ametaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT hsiehtsunghan ametaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT kungwoonman ametaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT chengchuhsuan ametaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT chenkuohu ametaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT tzengishiang metaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT kaomingchang metaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT panpoting metaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT chenchuting metaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT linhanyu metaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT hsiehpochun metaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT kuochanyen metaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT hsiehtsunghan metaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT kungwoonman metaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT chengchuhsuan metaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia AT chenkuohu metaanalysisofcomparingintermittentepiduralbolusesandcontinuousepiduralinfusionforlaboranalgesia |