An Innovative Approach to Determine Programmed Intermittent Epidural Bolus Pump Settings for Labor Analgesia: A Randomized Controlled Trial

丸(消化) 随机对照试验 医学 麻醉 外科
作者
Allana Munro,Ronald B. George,Pantelis Andreou
出处
期刊:Anesthesia & Analgesia [Lippincott Williams & Wilkins]
卷期号:139 (3): 545-554
标识
DOI:10.1213/ane.0000000000006813
摘要

BACKGROUND: Three settings are required on a programmed intermittent epidural bolus (PIEB) pump for labor analgesia: the PIEB next bolus (PIEBnb), PIEB interval (PIEBi), and PIEB volume (PIEBv). The ideal settings for these parameters are still unknown. We hypothesized a mathematical modeling tool, response surface methodology (RSM), could estimate 3 PIEB pump parameters while balancing 3 clinically important patient outcomes simultaneously. The study objective was to use RSM to estimate PIEB settings (PIEBnb, PIEBi, and PIEBv) while maximizing maternal satisfaction, minimizing the need for clinician-administered boluses, and optimizing the ratio of delivered/requested patient-controlled epidural analgesia (PCEA) boluses simultaneously. METHODS: With institutional ethics approval, a double-blind randomized trial was completed in a tertiary care labor and delivery center. Nulliparous, English-speaking American Society of Anesthesiologists (ASA) physical status II patients aged 18 to 45 years at full term, single gestation in vertex presentation, in spontaneous labor and ≤7 cm cervical dilation were included. Patients with comorbidities, contraindications to neuraxial analgesia, using chronic analgesics, <152 cm, or body mass index (BMI) >45 kg/m 2 were excluded. After informed consent, labor analgesia was initiated using 10 mL ropivacaine 0.2% with 10 µg/mL fentanyl solution and PCEA (volume 6 mL every 10 minutes). Patients were randomized to predetermined PIEB settings. RSM identified 3 pump settings that represented a stationary point that best maximized or minimized 3 outcomes simultaneously: PCEA ratio (a ratio closest to 1), clinician bolus (optimal is 0), and maternal satisfaction (visual analog scale, 0–100, ideal response is ≥90). RESULTS: Of 287 potential participants, 192 did not meet inclusion criteria or declined to participate, and 26 were withdrawn, leaving 69 patients for study inclusion. Using RSM, the suggested PIEB settings for all the primary study outcomes were as follows: PIEBnb = 29.4 minutes, PIEBi = 59.8 minutes, and PIEBv = 6.2 mL. These PIEB settings corresponded to the following clinical outcomes: maternal satisfaction at 93.9%, PCEA ratio at 0.77, and need for clinician bolus at 0.29. The dermatome sensory score was between T10 and T5 in 89% of the patients. The median lowest Bromage score was 4. CONCLUSIONS: This novel study used a mathematical model to estimate PIEB pump settings while simultaneously maximizing 3 clinical outcomes. Equally weighted clinical outcomes prevent maximal outcome optimization and may not reflect patient priorities. Future studies or quality improvement endeavors could use RSM methodology to estimate PIEB pump settings targeting optimal values for a single clinical outcome of determined importance to parturients.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
阡陌完成签到,获得积分0
1秒前
满意人英完成签到,获得积分10
2秒前
大气夜山完成签到 ,获得积分10
3秒前
Sindy完成签到,获得积分10
6秒前
wdd完成签到 ,获得积分10
8秒前
愉快无心完成签到 ,获得积分10
10秒前
淀粉肠完成签到 ,获得积分10
10秒前
愉快的犀牛完成签到 ,获得积分10
10秒前
11秒前
Zhusy完成签到 ,获得积分10
12秒前
12秒前
lx完成签到,获得积分10
13秒前
我是老大应助科研通管家采纳,获得10
14秒前
Xiaoxiao应助科研通管家采纳,获得10
15秒前
华仔应助科研通管家采纳,获得20
15秒前
15秒前
爆米花应助科研通管家采纳,获得10
15秒前
MQQ完成签到 ,获得积分10
17秒前
络桵完成签到,获得积分10
17秒前
曦夜发布了新的文献求助10
17秒前
狂野未来发布了新的文献求助150
22秒前
闻巷雨完成签到 ,获得积分10
24秒前
hebhm完成签到,获得积分10
24秒前
star完成签到,获得积分10
26秒前
26秒前
活力老少女完成签到 ,获得积分10
26秒前
steven完成签到 ,获得积分10
28秒前
30秒前
perway发布了新的文献求助10
31秒前
科研小郭完成签到,获得积分10
31秒前
五月完成签到 ,获得积分10
32秒前
QQLL完成签到,获得积分10
33秒前
mochen0722完成签到,获得积分10
38秒前
Mr.Ren完成签到,获得积分10
39秒前
青衫完成签到 ,获得积分10
40秒前
俏皮诺言完成签到,获得积分10
46秒前
夏夏完成签到,获得积分20
55秒前
氮化硼小兵完成签到,获得积分10
55秒前
拾壹完成签到,获得积分10
56秒前
友好语风完成签到,获得积分10
57秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
Cognitive Neuroscience: The Biology of the Mind 1000
Technical Brochure TB 814: LPIT applications in HV gas insulated switchgear 1000
Immigrant Incorporation in East Asian Democracies 600
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
A Preliminary Study on Correlation Between Independent Components of Facial Thermal Images and Subjective Assessment of Chronic Stress 500
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3968578
求助须知:如何正确求助?哪些是违规求助? 3513391
关于积分的说明 11167428
捐赠科研通 3248822
什么是DOI,文献DOI怎么找? 1794499
邀请新用户注册赠送积分活动 875116
科研通“疑难数据库(出版商)”最低求助积分说明 804664