Comparative study of programmed intermittent epidural boluses (PIEB) of 0.0625% bupivacaine 10 mL plus fentanyl 2 μg/mL at 90 min intervals in nulliparous versus multiparous parturients

Abstract

Background & objective: Effective pain relief during labor enhances maternal comfort, in addition to improving maternal and fetal outcomes. Various techniques of administering epidural analgesia include single bolus epidural analgesia, continuous epidural infusion, Patient-Controlled Epidural Analgesia (PCEA), Programmed Intermittent Epidural Bolus (PIEB), and PCEA with background infusion. Nulliparous and multiparous women exhibit distinct responses to labor pains. We compared the efficacy of PIEB in both multiparous and nulliparous participants.

Methodology: 30 patients undergoing normal vaginal delivery under epidural analgesia were included, and divided into two groups (15 per group), depending on whether they were nulliparous (Group N) or multiparous (Group M). All patients received PIEB in combination with PCEA. The primary outcome was to measure adequate labor analgesia using the Visual Analog Scale (VAS), the number of PCEA attempts, the volume administered via PCEA, and the timing of the first PCEA bolus. Time in the second stage of labor, and type of labor, were noted.

Results: The patients in Group N experienced greater pain from 4 to 7 hours than those in Group M, and this difference was statistically significant (P < 0.05). The mean time required to administer the first dose of PCEA bolus was significantly longer in Group M than in Group N (P = 0.0003). Similarly, Group N received significantly higher mean PCEA doses and volume of drug administered via PCEA than Group M, and the difference was significant (P < 0.0001).

Conclusion: The combination of PIEB and PCEA is an excellent method of providing labor analgesia in nulliparous as well as in multiparous women. However, nulliparous women are more likely to use top-up doses of PCEA as compared to multiparous women.

Abbreviations: PCEA: Patient-Controlled Epidural Analgesia, PIEB: Programmed Intermittent Epidural Bolus, VAS: Visual Analog Scale

Keywords: Labor Analgesia; Programmed Intermittent Epidural Bolus; Patient-Controlled Epidural Analgesia; Parity

Citation: Elfeky H, Habeeb R, Omran A. Comparative study of programmed intermittent epidural boluses (PIEB) of 10 mL bupivacaine 0.0625% plus 2 μg/mL fentanyl at 90 min intervals in nulliparous versus multiparous parturients. Anaesth. pain intensive care 2025;29(5):338-344. DOI: 10.35975/apic.v29i5.2636

Received: December 26, 2024; Revised: July 09, 2025; Accepted: July 10, 2025