Comparison between Continuous Epidural Infusion and Intermittent Epidural Bolus of Bupivacaine Fentanyl Combination for Labour Analgesia

Labour analgesia has become almost synonymous with central neuraxial analgesia. Various techniques are in use from single epidural injection, continuous epidural infusion, combined spinal epidural, patient controlled epidural analgesia to programmed intermittent epidural bolus. Each method has its own advantages and disadvantages though the purpose remains the same:a painless labour and a healthy neonate. We have compared two methods (continuous infusion and intermittent bolus) of epidural analgesics in our study. Sixty women were divided into two groups (Group A = 30 and Group B = 30) to receive either intermittent boluses or continuous infusion of a combination of bupivacaine and fentanyl (0.125% bupivacaine and 2microgram/ml fentanyl) in the first stage of labour. Pain relief was better in the intermittent bolus group (lower VAS score) with less requirement of rescue analgesics (four in Group A and twelve in Group B). Incidence of side effects was similar in both the groups. Timed intermittent boluses of epidural analgesics provided better analgesia than a continuous infusion of the same mixture. This method can be advocated where infusion pumps and automated delivery devices are not readily available in the labour suites.