Comparative Effects of Two Epidural Analgesia Maintenance Techniques on Labor Outcomes in Primiparous Women

Background: Labor is characterized by regular, painful uterine contractions, and epidural analgesia is considered the most effective method for relieving labor pain. Motor block from epidural local anesthetic administration can affect labor outcomes. The technique of epidural local anesthetic administration can also affect the outcome of labor. This study aimed to compare the progress of labor and delivery outcomes in women whose labor pain was managed with patient-controlled epidural analgesia (PCEA) and clinician-administered intermittent bolus epidural analgesia.

Methods: This prospective randomized study recruited 80 primiparous parturients in the active phase of labor in two groups. They received either self-administration of 5 ml of 0.125% bupivacaine + 2 µg fentanyl/ml of bupivacaine through the PCEA pump with a lockout interval of 20 minutes or hourly clinician-administered 10 ml of the same study solution. The outcome measures were duration of labor, fetal heart rate, APGAR score, mode of delivery, and willingness to request epidural analgesia in subsequent deliveries. Data was analyzed after a normality test with the Shapiro-Wilk test. Continuous variables such as age and duration of stages of labor were analyzed using the Student t-test. Nominal data such as mode of delivery was analyzed using the chi-square test or Fisher’s exact test as appropriate. Statistical significance was set at a p-value of <0.05.

Results: The mode of delivery was comparable between groups. There was no significant difference in duration of the first (p = 0.422) and second (p = 0.947) stages of labor between the two groups. Fetal outcomes were not adversely affected, and the median APGAR scores at 5 minutes were comparable (p = 0.083) between the two groups. The willingness to request epidural analgesia during labor for the next delivery was similar in the two groups (p = 0.414).

Conclusion: Hourly intermittent epidural bolus administration of bupivacaine with fentanyl had no adverse effects on labor and fetal outcomes compared to PCEA. Thus, it is recommended for use in low-resource regions without electronic infusion pumps.