PDF(Pubmed)
Abstract：
Background and Objectives: Local anesthetics administered via epidural catheters have evolved from intermittent top-ups to simultaneous administration of continuous epidural infusion (CEI) and patient-controlled epidural analgesia (PCEA) using the same device. The latest programmed intermittent epidural bolus (PIEB) model is believed to create a wider and more even distribution of analgesia inside the epidural space. The switch from CEI + PCEA to PIEB + PCEA in our department began in 2018; however, we received conflicting feedback regarding workload from the quality assurance team. This study aimed to investigate the benefits and drawbacks of this conversion, including the differences in acute pain service (APS) staff workload, maternal satisfaction, side effects, and complications before and after the changeover. Materials and Methods: Items from the APS records included total delivery time, average local anesthetic dosage, and the formerly mentioned items. The incidence of side effects, the association between the duration of delivery and total dosage, and hourly medication usage in the time subgroups of the CEI and PIEB groups were compared. The staff workload incurred from rescue bolus injection, catheter adjustment, and dosage adjustment was also analyzed. Results: The final analysis included 214 and 272 cases of CEI + PCEA and PIEB + PCEA for labor analgesia, respectively. The total amount of medication and average hourly dosage were significantly lower in the PIEB + PCEA group. The incidences of dosage change, manual bolus, extra visits per patient, and lidocaine use for rescue bolus were greater in the PIEB + PCEA group, indicating an increased staff workload. However, the two groups did not differ in CS rates, labor time, maternal satisfaction, and side effects. Conclusions: This study revealed that while PIEB + PCEA maintained the advantage of decreasing total drug doses, it inadvertently increased the staff burden. Increased workload might be a consideration in clinical settings when choosing between different methods of PCEA.
摘要：
背景和目的：通过硬膜外导管给药的局部麻醉药已经从间歇性补充发展到使用相同设备同时进行连续硬膜外输注（CEI）和患者自控硬膜外镇痛（PCEA）。最新的程序间歇性硬膜外推注（PIEB）模型被认为可以在硬膜外腔内产生更广泛，更均匀的镇痛分布。我们部门从CEI+PCEA切换到PIEB+PCEA始于2018年；然而，我们收到了来自质量保证团队的关于工作量的相互矛盾的反馈。本研究旨在探讨这种转换的利弊，包括急性疼痛服务(APS)工作人员工作量的差异，产妇满意度,副作用,以及转换前后的并发症。材料和方法：APS记录中的项目包括总交货时间，局麻药平均用量,和前面提到的项目。副作用的发生率，分娩持续时间和总剂量之间的关联，比较CEI和PIEB组时间亚组的每小时用药情况。救援推注造成的工作人员工作量，导管调节,并对剂量调整进行了分析。结果:CEI+PCEA和PIEB+PCEA分别用于分娩镇痛214例和272例,分别。PIEB+PCEA组的药物总量和平均每小时剂量显著降低。剂量变化的发生率，手动推注，每位患者的额外就诊次数，在PIEB+PCEA组中，利多卡因用于救援推注更多，表明工作人员的工作量增加。然而,两组的CS率没有差异，劳动时间,产妇满意度,和副作用。结论：这项研究表明，虽然PIEB+PCEA保持了降低总药物剂量的优势，它无意中增加了员工的负担。在选择不同的PCEA方法时，在临床环境中可能需要考虑增加工作量。
