OBJECTIVE

To evaluate an effectiveness of the available modes of epidural analgesia (bolus, patient-controlled epidural analgesia, patient-controlled epidural analgesia combined with continuous epidural infusion, programmed intermittent epidural bolus combined with patient-controlled epidural analgesia) in parallel with a stepwise decrease in levobupivacaine concentration for analysis of optimal ratio «mode — concentration of anesthetic» in labor pain relief.

MATERIAL AND METHODS

We studied 145 women. The onset of pain relief was determined by regular labor. All women were divided into 5 groups depending on the mode of pain relief and local anesthetic concentration: on-demand manual boluses, patient-controlled epidural analgesia (PCEA), patient-controlled epidural analgesia combined with continuous epidural infusion (PCEA + CEI), programmed intermittent epidural bolus combined with patient-controlled epidural analgesia (PIEB + PCEA); levobupivacaine 0.25 mg/ml; 1.25 mg/ml; 0.625 mg/ml. Labor pain relief efficacy was evaluated using a visual analogue scale. The time points for recording the values were as follows: before anesthesia, after 15 minutes from anesthesia onset, every 30 minutes until the uterine cervix is completely opened and during labor contractions at the delivery room.

RESULTS

Combined modes of epidural analgesia (PCEA + CEI, PCEA + PIEB) ensure more consistent and effective analgesia of labor stage I compared to bolus techniques (on-demand or PCEA). However, the greatest decrease in pain intensity during stage I (p<0.00002) and II (p<0.0004) was achieved in the 5^th group (PIEB+PCEA) in absolute and relative units.

CONCLUSION

PIEB combined with PCEA was characterized by the greatest efficacy for labor pain relief.