Review
Anesthesiology
Fanshu Ni, Ziyi Wu, Ping Zhao
Summary: Programmed intermittent epidural bolus (PIEB) is a technique that delivers boluses of epidural solution at certain intervals, and it has been gaining attention as a method to maintain labor analgesia. This review aims to discuss the effects of PIEB in combination with continuous epidural infusion (CEI) and patient-controlled epidural analgesia (PCEA) on labor outcomes and provide an update on the latest research progress in implementation strategies. A literature search was conducted, and 27 studies published between January 2010 and June 2022 were included in the review.
JOURNAL OF ANESTHESIA
(2023)
Review
Medicine, General & Internal
Xian-xue Wang, Xiao-lan Zhang, Zhao-xia Zhang, Zi-qin Xin, Hua-jing Guo, Hai-yan Liu, Jing Xiao, Yun-lin Zhang, Shu-zhen Yuan
Summary: This study evaluated the efficacy and safety of programmed intermittent epidural bolus (PIEB) for labor analgesia. The results showed that PIEB was associated with decreased drug consumption, reduced need for patient-controlled analgesia, higher satisfaction scores, and increased rate of normal delivery.
Article
Anesthesiology
Yujie Song, Weijia Du, Shuangqiong Zhou, Yao Zhou, Yibing Yu, Zhendong Xu, Zhiqiang Liu
Summary: In labor analgesia, the DPE technique with PIEB mode showed faster onset, reduced anesthetic drug consumption, and no increase in maternal or neonatal side effects compared to other techniques.
ANESTHESIA AND ANALGESIA
(2021)
Article
Medicine, General & Internal
Ming Yan, Qiao Wang, Yufeng Zhang, Jing Zhou, Enhui Cui, Jian Sun
Summary: This study demonstrates that the dural puncture epidural technique combined with programmed intermittent epidural bolus mode for labor analgesia provides faster analgesia, reduces the consumption of ropivacaine, and decreases the incidence of incomplete analgesia and intrapartum fever compared to conventional methods.
Article
Obstetrics & Gynecology
Xin Ran, Shuzhi Zhou, Kailan Cao, Peng He
Summary: This study assessed the effectiveness of programmed intermittent epidural bolus (PIEB) with different concentrations of ropivacaine and sufentanil in obstetric analgesia. It found that the optimal bolus volume for 0.075% ropivacaine and 0.5 mu g/mL sufentanil was 10 mL, while for 0.1% ropivacaine and 0.5 mu g/mL sufentanil was 9 mL, with a 40-minute interval.
BMC PREGNANCY AND CHILDBIRTH
(2022)
Article
Health Care Sciences & Services
Shih-Kai Liu, Shao-Chun Wu, Shao-Chi Hung, Kuen-Bao Chen, Amina M. M. Illias, Yung-Fong Tsai
Summary: The programmed intermittent epidural bolus (PIEB) setting in conjunction with a patient-controlled epidural analgesia (PCEA) setting can improve the quality of labor analgesia, reduce the number of medical staff, and increase patient satisfaction.
Article
Anesthesiology
Yujie Song, Weijia Du, Yiyi Tao, Qian Li, Fuyi Shen, Zhendong Xu, Zhiqiang Liu
Summary: The optimal interval time for PIEB boluses of ropivacaine 0.1% and sufentanil 0.3 mu g/mL when using the DPE technique was approximately 41 minutes.
JOURNAL OF CLINICAL ANESTHESIA
(2022)
Article
Medicine, General & Internal
Ru-Ying Pang, Yao-Hua Shen, Xiao-Qin Jin, Hai-Feng Xu, Yang Wang, Bin-Xiang Zhu, Su-Feng Lin, Fei Xiao
Summary: This study evaluated the efficacy of combining different doses of dexmedetomidine or fentanyl with ropivacaine for labor analgesia. The results showed that dexmedetomidine (0.3 and 0.4 μg/ml) reduced the amount of ropivacaine administered and minimized opioid-related side effects. This study provided evidence for the potential of dexmedetomidine as an alternative to opioids for labor analgesia, and further research is needed to confirm its benefits.
FRONTIERS IN MEDICINE
(2022)
Article
Medicine, General & Internal
Yeon-Ju Kim, Do-Kyeong Lee, Hyun-Jung Kwon, Hye-Mee Kwon, Jong-Hyuk Lee, Doo-Hwan Kim, Sung-Moon Jeong
Summary: By analyzing data from patients undergoing major upper abdominal surgery, we compared the effects of programmed intermittent epidural bolus and continuous epidural infusion on postoperative opioid consumption, pain intensity, and local anesthetic consumption. Our results showed no significant differences between the two groups, indicating comparable postoperative analgesia quality and safety following major upper abdominal surgery. However, further evaluation of programmed intermittent epidural bolus is needed.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Medicine, General & Internal
Su-Sung Lee, Ji-Hye Baek, Soon-Ji Park, Hye-Jin Kim, Hee-Young Kim, Gyeong-Jo Byeon
Summary: This study investigated the effects of programmed intermittent epidural bolus injection versus continuous epidural injection on controlling nighttime pain and improving sleep quality after thoracotomy. The results showed that the programmed intermittent epidural bolus technique reduced postoperative nighttime pain, increased total sleep time, and improved satisfaction with sleep quality.
Article
Anesthesiology
Daniel Shatalin, Cristian Arzola, Kristi Downey, Xiang Y. Ye, Jose C. A. Carvalho
Summary: The study found that injecting 2.5 mL of bupivacaine 0.25% with fentanyl 8 mu g center dot mL(-1) every 20 minutes during the first stage of labor can produce effective analgesia. Additionally, there is no significant advantage in using this regimen compared to literature reports using the same dose of bupivacaine at concentrations of 0.0625% and 0.125%.
CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE
(2021)
Article
Anesthesiology
Joshua D. Younger, Ahmad Faryami, Monica Prasad, Daniel Viar, Adam Menkara, Amy Tang, Carolyn A. Harris
Summary: The programmable intermittent epidural bolus (PIEB) is a popular technique for labor analgesia, with advantages including reduced local anesthetic consumption and improved maternal satisfaction. However, manual boluses are still used for breakthrough pain when PIEB is not effective.
ANESTHESIA AND ANALGESIA
(2023)
Article
Anesthesiology
Julia F. Casellato, Xiang Y. Ye, Kristi Downey, Jose C. A. Carvalho
Summary: This study investigated the variations of upper and lower sensory block levels within programmed intermittent epidural bolus cycles.
CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE
(2022)
Article
Anesthesiology
E. Roofthooft, N. Filetici, M. Van Houwe, P. Van Houwe, A. Barbe, S. Fieuws, S. Rex, C. A. Wong, M. Van de Velde
Summary: The aim of neuraxial analgesia is to achieve excellent pain relief with the fewest adverse effects. The programmed intermittent epidural bolus technique has been introduced as a maintenance technique for epidural analgesia. Compared to patient-controlled epidural analgesia without background infusion, programmed intermittent epidural bolus is associated with less breakthrough pain, lower pain scores, higher local anaesthetic consumption, and comparable motor block.
Article
Anesthesiology
Luyang Wang, Zhanhuai Wu, Lijuan Hu, Yuan Wang
Summary: The study aimed to evaluate the efficacy of programmed intermittent epidural boluses (PIEB) compared with continuous epidural infusion (CEI) for postoperative pain management after cesarean delivery. Results showed that patients receiving PIEB had lower pain scores at rest and on movement at 12 hours compared to those receiving CEI, with less total ropivacaine consumption at 48 hours.
JOURNAL OF ANESTHESIA
(2022)
Review
Obstetrics & Gynecology
Elliott C. Callahan, Won Lee, Pedram Aleshi, Ronald B. George
Summary: Epidural analgesia is an important method of pain control during labor. It may slightly prolong labor and has no increased risk of cesarean delivery. Advances in the technique have reduced the risk of assisted vaginal delivery by reducing anesthetic dose.
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
(2023)
Article
Anesthesiology
J. E. O'Carroll, L. Zucco, E. Warwick, G. Arbane, S. R. Moonesinghe, K. El-Boghdadly, N. Guo, B. Carvalho, P. Sultan
Summary: To assess postpartum recovery in patients receiving peripartum anaesthetic interventions, a UK-based multicentre cohort study was conducted. Data on recovery metrics, including quality of recovery measures, pain scores, length of hospital stay, readmission rates, and complications, were collected at 1 and 30 days postpartum. The study included 1638 patients, and the results showed variations in recovery outcomes based on delivery mode and identified a subset of patients who experienced complications and readmissions.
Letter
Anesthesiology
S. Coppens, R. B. George, S. Rex
Letter
Anesthesiology
Christopher Cheung, Hilary MacCormick, Allana Munro, Ronald B. George
CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE
(2023)
Review
Anesthesiology
Won Lee, Marina Souto Martins, Ronald B. George, Alicia Fernandez
Summary: This scoping review examines racial and ethnic disparities in obstetric anesthesia during the peripartum period in the USA. The findings suggest that there are inequalities in obstetric anesthesia service and its clinical outcomes among different racial and ethnic groups.
CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE
(2023)
Article
Cell Biology
Davide De Francesco, Jonathan D. Reiss, Jacquelyn Roger, Alice S. Tang, Alan L. Chang, Martin Becker, Thanaphong Phongpreecha, Camilo Espinosa, Susanna Morin, Eloise Berson, Melan Thuraiappah, Brian L. Le, Neal G. Ravindra, Seyedeh Neelufar Payrovnaziri, Samson Mataraso, Yeasul Kim, Lei Xue, Melissa G. Rosenstein, Tomiko Oskotsky, Ivana Maric, Brice Gaudilliere, Brendan Carvalho, Brian T. Bateman, Martin S. Angst, Lawrence S. Prince, Yair J. Blumenfeld, William E. Benitz, Janene H. Fuerch, Gary M. Shaw, Karl G. Sylvester, David K. Stevenson, Marina Sirota, Nima Aghaeepour
Summary: Despite prematurity being the primary cause of death in children under 5 years old, the current definition based on gestational age lacks precision for guiding care decisions. This study proposes a deep learning model that uses electronic health records (EHRs) to predict neonatal outcomes starting before conception and extending months after birth. The model achieved high accuracy in predicting various neonatal outcomes and identified associations between maternal and neonatal features and specific outcomes. With a dataset of over 30,000 mother-newborn dyads, this study provides a valuable resource for investigating and predicting neonatal outcomes.
SCIENCE TRANSLATIONAL MEDICINE
(2023)
Article
Anesthesiology
Gillian Abir, Edward T. T. Riley, Ann Marie Oakeson, Amy Judy, Ellen Wang, Brendan Carvalho
Summary: Multidisciplinary team management is crucial for optimizing postpartum hemorrhage care. Lucile Packard Children's Hospital, Stanford, has implemented an automated alert system to ensure prompt evaluation by the obstetric anesthesia team when a second-line uterotonic drug is administered. This system has improved communication and reduced failure to inform the obstetric anesthesiology team of PPH after vaginal and cesarean deliveries.
Article
Health Care Sciences & Services
Grace Lim, Annamarie J. Lim, Beth Quinn, Brendan Carvalho, Mark Zakowski, Grant C. Lynde
Summary: This study used Queuing Theory Analysis (QTA) to identify optimal birth center operating room (OR) and staffing resources using real-world data. The findings suggest that QTA can inform individual hospital-level decisions in setting staffing and space requirements to achieve safe and efficient maternity perioperative care.
BMC HEALTH SERVICES RESEARCH
(2023)
Review
Anesthesiology
Preet M. Singh, Pervez Sultan, James O'Carroll, Lindsay Blake, Brendan Carvalho, Narinder P. Singh, David T. Monks
Summary: This article conducted a systematic review and network meta-analysis to compare the relative efficacy of different interventions in reducing the incidence of pruritus induced by single-shot intrathecal or epidural morphine in Caesarean delivery. The results showed that some interventions can effectively reduce the incidence of pruritus.
BRITISH JOURNAL OF ANAESTHESIA
(2023)
Correction
Anesthesiology
C. F. Weiniger, B. Carvalho, I. Ronel, C. Greenberger, B. Aptekman, O. Almog, G. Kagan, S. Shalev
INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA
(2023)
Article
Health Care Sciences & Services
Kelly Fedoruk, James Xie, Ellen Wang, Cedar Fowler, Edward Riley, Brendan Carvalho
Summary: The use of electronic medical record (EMR) nudges significantly improved the accuracy of documentation of neuraxial block replacements by obstetric anaesthesiologists, and increased adherence to quality metric monitoring.
Review
Obstetrics & Gynecology
James O. ' Carroll, Kazuo Ando, Romy Yun, Danielle Panelli, Angela Nicklin, Natasha Kennedy, Brendan Carvalho, Lindsay Blake, Jessica Coker, Debra Kaysen, Pervez Sultan
Summary: This study aimed to identify the best patient-reported outcome measure for postpartum anxiety by conducting a systematic review and evaluating the psychometric properties of instruments. Five instruments were recommended for use, but with limitations. Future research is needed to determine the optimal instrument or develop a more specific measure for maternal postpartum anxiety.
AMERICAN JOURNAL OF OBSTETRICS & GYNECOLOGY MFM
(2023)
Article
Anesthesiology
Kariem El-Boghdadly, Eric Albrecht, Morne Wolmarans, Edward R. Mariano, Sandra Kopp, Anahi Perlas, Athmaja Thottungal, Jeff Gadsden, Serkan Tulgar, Sanjib Adhikary, Jose Aguirre, Anne M. R. Agur, Basak Altiparmak, Michael J. Barrington, Nigel Bedforth, Rafael Blanco, Sebastien Bloc, Karen Boretsky, James Bowness, Margaretha Breebaart, David Burckett-St Laurent, Brendan Carvalho, Jacques E. Chelly, Ki Jinn Chin, Alwin Chuan, Steve Coppens, Ioana Costache, Mette Dam, Matthias Desmet, Shalini Dhir, Christian Egeler, Hesham Elsharkawy, Thomas Fichtner Bendtsen, Ben Fox, Carlo D. Franco, Philippe Emmanuel Gautier, Stuart Alan Grant, Sina Grape, Carrie Guheen, Monica W. Harbell, Peter Hebbard, Nadia Hernandez, Rosemary M. G. Hogg, Margaret Holtz, Barys Ihnatsenka, Brian M. Ilfeld, Vivian H. Y. Ip, Rebecca L. Johnson, Hari Kalagara, Paul Kessler, M. Kwesi Kwofie, Linda Le-Wendling, Philipp Lirk, Clara Lobo, Danielle Ludwin, Alan James Robert Macfarlane, Alexandros Makris, Colin Mccartney, John Mcdonnell, Graeme A. Mcleod, Stavros G. Memtsoudis, Peter Merjavy, E. M. Louise Moran, Antoun Nader, Joseph M. Neal, Ahtsham U. Niazi, Catherine Njathi-Ori, Brian D. O'Donnell, Matt Oldman, Steven L. Orebaugh, Teresa Parras, Amit Pawa, Philip Peng, Steven Porter, Bridget P. Pulos, Xavier Sala-Blanch, Andrea Saporito, Axel R. Sauter, Eric S. Schwenk, Maria Paz Sebastian, Navdeep Sidhu, Sanjay Kumar Sinha, Ellen M. Soffin, James Stimpson, Raymond Tang, Ban C. H. Tsui, Lloyd Turbitt, Vishal Uppal, Geert J. van Geffen, Kris Vermeylen, Kamen Vlassakov, Thomas Volk, Jeff L. Xu, Nabil M. Elkassabany
Summary: Through a Delphi international consensus study, standardized names and anatomical descriptions for upper and lower limb peripheral nerve blocks were established, with strong consensus achieved for the majority of items. This framework will improve research, education, and clinical practice in regional anesthesia, ultimately benefiting patient care.
REGIONAL ANESTHESIA AND PAIN MEDICINE
(2023)
Article
Medicine, General & Internal
Vesela P. Kovacheva, William Armero, Guohai Zhou, David Bishop, Robert Dyer, Brendan Carvalho
Summary: Maintaining higher intraoperative blood pressure using individual pre-spinal MAP as baseline can reduce the occurrence of maternal nausea during cesarean delivery under spinal anesthesia. Using pre-spinal MAP as the baseline reference value in intraoperative blood pressure monitoring can effectively guide the management of hypotension.
CUREUS JOURNAL OF MEDICAL SCIENCE
(2023)
Article
Anesthesiology
Din H. Ben Hayoun, Pervez Sultan, Jonathan Rozeznic, Nan Guo, Brendan Carvalho, Sharon Orbach-Zinger, Carolyn F. Weiniger
Summary: The study aimed to explore the relationship between Obstetric Quality of Recovery survey and Edinburgh postnatal depression scale measured 6 weeks after delivery. The results showed that lower quality of recovery during hospitalization, pre-existing depression or anxiety, and hospital readmission were associated with positive screening for postpartum depression at 6 weeks.
JOURNAL OF CLINICAL ANESTHESIA
(2023)