Obstetric Anaesthesia Annual Scientific Meeting 2023

Title - Comparison of Epidural Infusion Methods for Labour

Authors - A Kedia (ST5), R Ellis (ST7), A Philips (Consultant), Nottingham City Hospital, Nottingham University Hospitals

1. Introduction

Epidural analgesia for labour is routinely delivered in our centre using high-flow infusion sets using PIEB*/PCEA** programme.
Due to challenges with supply chains, we used low-flow infusion sets with two programmes - CEI***/PCEA (adopted from general surgery) and PIEB/PCEA (approved later).
This provided us a unique opportunity to compare the effectiveness of all the delivery methods.

2. Methods

Data was collected using 106 records retrospectively.
39 women received epidural analgesia via high-flow sets using PIEB/PCEA, 32 via low-flow sets using PIEB/PCEA and 35 via low-flow sets using CEI/PCEA.
We looked at the impact on anaesthetic service, neurological observations and outcome of labour.
Fisher’s Exact Test used to compare the difference.

3. Results

Women on CEI/PCEA required more anaesthetic reviews (p = 0.003) and clinician boluses (p = 0.005) compared to those on PIEB/PCEA via both the sets.
Frequency of motor block during labour was higher with CEI/PCEA (p = 0.03).
The incidence of Caesarean section was comparable across the groups.
The need for instrumental delivery was lower with CEI/PCEA (13.9%) compared to PIEB/PCEA (28.2%) but this difference was not statistically significant (p = 0.15).
The combined incidence of Caesarean section and instrumental delivery was similar for CEI/PCEA and PIEB/PCEA (65.7% and 67.6% respectively).
The high-flow and low-flow sets using PIEB/PCEA had comparable outcomes in all aspects.

4. Discussion

The comparable outcomes of high-flow and low-flow sets with PIEB/PCEA programme suggests that low-flow sets are a suitable alternative.
CEI/PCEA had significant negative impact on anaesthetic service and neurological observations. This is consistent with the existing literature¹.
The outcome of labour was comparable across all the groups.

Comparison of Epidural Infusion Methods for Labour Analgesia