Observation Of The Effect Of Epidural Analgesia Combined With Programmed Pulse Infusion After Dural Perforation In Labor Analgesia

Objective:This study intends to observe the clinical application effect of dural epidural analgesia（DPE）combined with programmed intermittent epidural bolus infusion（PIEB）in labor analgesia,so as to put forward a theoretical basis for further improving the labor analgesia scheme.Methods:119 singleton term primiparas who volunteered to receive labor analgesia in the first hospital of Shanxi Medical University from August 2020 to August 2021 were randomly divided into EP+CEI group（group A,n=30）,EP+PIEB group（group B,n=30）,DPE+CEI group（Group C,n=30）and DPE+PIEB group（Group D,n=29）.The parturients in each group were given labor analgesia,and 3ml of 1.5%lidocaine was injected after the epidural catheter was placed.No local anesthetic poisoning and other abnormalities were observed after 5min.After that,the first dose of 0.125%ropivacaine+0.4ug/ml sufentanil 5ml was injected through the epidural catheter.Connect the epidural catheter to the analgesia pump and set the parameters.The visual analogue scale（VAS）of parturients at these time-points were recorded before analgesia（T₀）,after analgesia 5 min（T₁）,10 min（T₂）,20 min（T₃）,30 min（T₄）,60 min（T₅）and 120 min（T₆）respectively to evaluate the degree of labor pain during uterine contraction.The modified Bromage score at T₄time point and immediately after delivery,neonatal Apgar score,maternal adverse reactions,demand for patient-controlled analgesia and drug consumption were compared.Results:There was no significant difference in VAS pain score before labor analgesia（T₀）between groups（P>0.05）.The time of reaching VAS≤3 in DPE+CEI group and DPE+PIEB group was significantly faster than that in EP+CEI group and EP+PIEB group（P<0.05）;The drug consumption of sufentanil and ropivacaine in DPE+PIEB group was significantly lower than that in the other three groups（P<0.05）.There was no significant difference in maternal Bromage score at T₄time point and immediately after delivery,maternal adverse reaction rate,neonatal Apgar score and neonatal weight among the groups（P>0.05）.Conclusion:The combination of DPE blocking technology and PIEB administration mode can ensure a faster onset time,play a more complete analgesic effect,reduce the consumption of anesthetics,and have a small impact on the neonatal outcome,Does not increase the incidence of maternal adverse reactions.It proves that the combination of DPE blocking technology and PIEB administration mode can be used as a more optimized delivery analgesia program in clinical promotion.