• Yujie Song, Yingcai Song, Zhihao Sheng, Qingsong Zhao, Wei Liu, Yujie Li, Yu Zang, Zhendong Xu, and Zhiqiang Liu.
• Department of Anesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
• Can J Anaesth. 2024 Oct 21.

PurposeTo determine the optimal programmed intermittent epidural bolus (PIEB) volume for providing effective analgesia in 90% of patients (EV90) during the first stage of labour using the dural puncture epidural (DPE) technique to initiate labour analgesia.MethodsWe conducted a biased-coin up-and-down sequential allocation study. We included 40 nulliparous women requiring epidural labour analgesia. We used a 25G Whitacre spinal needle to puncture the dural mater and then administered a loading dose of 12 mL of ropivacaine 0.1% and sufentanil 0.3 μg·mL-1. Subsequently, the PIEB pump delivered boluses with an identical solution at a fixed 40-min interval, starting 1 hr after epidural initiation. The bolus volume for the first patient was 7 mL and was adjusted for subsequent patients according to the study protocol (bolus volume, 7-12 mL). The primary endpoint was effective analgesia, indicated by no need for patient-controlled or manual boluses within 6 hr after analgesia initiation or until complete cervical dilation, whichever came first. Outcome evaluators assessed the patients' pain ratings, Bromage scores, sensory blockade level, and maternal blood pressure hourly.ResultsUsing the truncated Dixon and Mood method, the estimated EV90 was 9.2 mL (95% confidence interval [CI], 8.5 to 9.9) whereas the isotonic regression method yielded a value of 8.8 mL (95% CI, 8.6 to 9.8). None of the patients experienced a motor block. Two patients experienced hypotension without the need for vasopressors.ConclusionsThe estimated PIEB EV90 for ropivacaine 0.1% and sufentanil 0.3 μg·mL-1 approached 9 mL when DPE was combined with a fixed 40-min interval.Study RegistrationChiCTR.org.cn ( ChiCTR2300067281 ); first submitted 3 January 2023.© 2024. Canadian Anesthesiologists' Society.

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