title: Programmed intermittent epidural bolus versus continuous epidural infusion for pain relief during termination of pregnancy: a prospective, double-blind, randomized trial.
abstract: BACKGROUND
  Pain is a major concern during medical abortion but no evidence-based recommendations for optimal analgesia during medical termination of pregnancy are available. We compared two methods of epidural analgesia during second trimester termination of pregnancy, with the primary aim of assessing the incidence of motor block.
  
  
  METHODS
  Women were randomly assigned to receive continuous epidural infusion (CEI Group; n=52) or programmed intermittent epidural bolus (PIEB Group; n=52). Assessment of motor block was performed every hour. Patients with a modified Bromage score <6 were considered to have motor block.
  
  
  RESULTS
  Motor block occurred more frequently in the CEI Group compared with the PIEB Group (46.2% vs. 5.8%, P<0.001). Pain scores were low and comparable between groups. Patients in the CEI Group experienced nausea more frequently than those in the PIEB Group (34.6% vs. 13.5%, P=0.022). The degree of satisfaction was higher in the PIEB Group compared with the CEI Group.
  
  
  CONCLUSIONS
  During second trimester termination of pregnancy in our patient groups, a programmed intermittent epidural bolus technique was associated with less motor block and greater patient satisfaction than continuous epidural infusion. Both techniques had similar analgesic efficacy.
authors.affiliation: Unit of Obstetrics and Gynecology, IRCCS AOU San Martino - IST, Genova, Italy. Electronic address: ulrm@me.com.
authors.forename: U
authors.initials: U
authors.lastname: Leone Roberti Maggiore
authors.affiliation: Anesthesiology Unit, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Genoa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Silanos
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino Hospital and National Institute for Cancer Research, University of Genoa, Genoa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Carlevaro
authors.affiliation: Anesthesiology Unit, IRCCS San Martino Hospital and National Institute for Cancer Research, University of Genoa, Genoa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gratarola
authors.affiliation: Unit of Obstetrics and Gynecology, IRCCS AOU San Martino - IST, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.
authors.forename: P L
authors.initials: PL
authors.lastname: Venturini
authors.affiliation: Unit of Obstetrics and Gynecology, IRCCS AOU San Martino - IST, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ferrero
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino Hospital and National Institute for Cancer Research, University of Genoa, Genoa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Pelosi
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies
keywords: Analgesia; Epidural; Labor; Motor block; Termination of pregnancy