Programmed Intermittent Epidural Bolus vs Continuous Epidural Infusion for Labor Analgesia: A Comparative Study of Maternal Satisfaction and Breakthrough Pain.

Authors

Maria Sgouraki, Pooja Sahu, Amiya Kumar Nayak, Heena Dixit, Jasmine Kalsi, Akriti Mahajan

Published in

Cureus. Volume 18. Issue 6. Pages e110560. Epub Jun 09, 2026.

Abstract

Introduction Effective labor analgesia plays a crucial role in improving maternal comfort and the overall childbirth experience. The aim of the present study was to compare maternal satisfaction and breakthrough pain between programmed intermittent epidural bolus (PIEB) and continuous epidural infusion (CEI) techniques for labor analgesia. Materials and methods This cross-sectional study was conducted in the Department of Anesthesiology among 192 term pregnant women who received epidural labor analgesia. The participants were equally divided into PIEB (n = 96) and CEI (n = 96) groups according to the maintenance epidural regimen received during labor. Maternal satisfaction was assessed using a 0-10 numeric rating scale. Secondary outcomes included breakthrough pain, physician-administered rescue boluses, patient-controlled epidural analgesia (PCEA) utilization, analgesic consumption, adverse events, and willingness to repeat the same analgesic technique. Statistical analysis was performed with p < 0.05 considered statistically significant. Results Maternal satisfaction scores were significantly higher in the PIEB group than in the CEI group (8.6 ± 0.9 vs. 7.9 ± 1.2; p = 0.001). High satisfaction (score ≥8) was observed in 72 (75.0%) participants in the PIEB group compared with 56 (58.3%) in the CEI group. Breakthrough pain occurred less frequently in the PIEB group than in the CEI group (p = 0.011). The number of physician-administered top-up boluses and PCEA activation was significantly lower in the PIEB group. Total local anesthetic volume and fentanyl consumption were also significantly reduced in the PIEB group (p < 0.05). Adverse maternal events were low and comparable between the groups. Conclusions PIEB provided superior maternal satisfaction and improved analgesic efficacy with lower anesthetic consumption than CEI while maintaining a comparable safety profile. These findings support the use of PIEB as an effective maintenance strategy for epidural analgesia during labor.

PMID:
42434670
Bibliographic data and abstract were imported from PubMed on 11 Jul 2026.

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