Research Article

Comparison of the Effect of Epidural Bolus and Continuous Infusion of Lidocaine %1 on Pain, the Progress of Vaginal Delivery and Motor Function in Labor Epidural Analgesia


Background: The pain of childbirth is the most severe pain that a woman experiences. This study aimed to compare the effect of epidural bolus and epidural continuous infusion of lidocaine %1 on pain and progress of vaginal delivery and motor function in labor epidural analgesia.
Methods: This randomized clinical trial was conducted on 50 pregnant women aged between 18-45 years. They were randomly assigned into two groups of bolus injections of lidocaine1% and continuous infusion using an epidural approach. The evaluated variables included systolic and diastolic blood pressures, mean arterial pressure, pain score, heart rate, satisfaction rate, nausea, vomiting, itching, the progress of delivery, and the level of motor and sensory block. The collected data were analyzed in SPSS software (Version 21). P-value less than 0.05 was considered statistically significant.
Results: Two groups were similar in age. There were no significant differences between two groups in terms of mean diastolic blood pressure, incidence of hypotension and C/S rate (P> 0.005). Mean arterial pressure, sedation score and neonatal Apgar scores in the first and fifth minutes in the continuous group were significantly lower than the bolus group.
Pain score (VAS) in the bolus group) 2.55±1.04 (was significantly lower than infusion group (5.22±2.50). The length of the first and second stages of labor in the bolus group (42.28 and 34.12) was less than continuous infusion (47.04 and 47.00) (P< 0.005).
Conclusion: In women undergoing epidural analgesia, epidural bolus injection of lidocaine 1% is associated with greater analgesia and satisfaction than continuous infusion.

[1] Junge C, von Soest T, Weidner K, Seidler A, Eberhard-Gran M, Garthus-Niegel S. Labor pain in women with and without severe fear of childbirth: A population-based, longitudinal study. 2018; 45(4):469-77.
[2] McKenzie C, Cobb B, Riley E, Carvalho B. Programmed intermittent epidural boluses for maintenance of labor analgesia: an impact study. Int J Obstet Anesth. 2016; 26:32-8.
[3] Manouchehrian N, Rabiei S, Moradi A, Lakpur Z. Comparison of Intrathecal Injection of Fentanyl and Sufentanil on the Onset, Duration, and Quality of Analgesia in Labor: A Randomized, Double-Blind Clinical Trial. Anesth Pain Med. 2020; 10(3): e99843.
[4] Powell MF, Jarzombek KW, Venhuizen KJ, Tubinis MD, Morgan CJ, Frölich MA. Comparing Bupivacaine, Lidocaine, and a Combination of Bupivacaine and Lidocaine for Labor Epidural Activation: A Prospective, Randomized, Double-Blind Study. Asian J Anesthesiol.2019; 57(2): 55-60.
[5] Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev. 2012; 10:Cd004350.
[6] Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016; 124(2):270-300.
[7] Van der Vyver M, Halpern S, Joseph G. Patient-controlled epidural analgesia versus continuous infusion for labour analgesia: a meta-analysis. Br J Anaesth. 2002; 89(3):459-65.
[8] Halpern SH, Carvalho B. Patient-controlled epidural analgesia for labor. Anesth Analg. 2009; 108(3):921-8.
[9] Capogna G, Camorcia M, Stirparo S, Farcomeni A. Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia: the effects on maternal motor function and labor outcome. A randomized double-blind study in nulliparous women. Anesth Analg. 2011; 113(4):826-31.
[10] Chua SM, Sia AT. Automated intermittent epidural boluses improve analgesia induced by intrathecal fentanyl during labour. Can J Anaesth. 2004; 51(6):581-5.
[11] Fettes P, Moore C, Whiteside J, McLeod G, Wildsmith J. Intermittent vs continuous administration of epidural ropivacaine with fentanyl for analgesia during labour. Br J Anaesth. 2006; 97(3):359-64.
[12] Leo S, Ocampo C, Lim Y, Sia A. A randomized comparison of automated intermittent mandatory boluses with a basal infusion in combination with patient-controlled epidural analgesia for labor and delivery. Int J Obstet Anesth. 2010; 19(4):357-64.
[13] Lim Y, Chakravarty S, Ocampo CE, Sia AT. Comparison of automated intermittent low volume bolus with continuous infusion for labour epidural analgesia. Anaesth Intensive Care. 2010; 38(5):894-9.
[14] Sia AT, Lim Y, Ocampo C. A comparison of a basal infusion with automated mandatory boluses in parturient-controlled epidural analgesia during labor. Anesth Analg. 2007 Mar;104(3):673-8.
[15.] Wong CA, Ratliff JT, Sullivan JT, Scavone BM, Toledo P, McCarthy RJ. A randomized comparison of programmed intermittent epidural bolus with continuous epidural infusion for labor analgesia. Anesth Analg. 2006; 102(3):904-9.
[16] George RB, Allen TK, Habib AS. Intermittent epidural bolus compared with continuous epidural infusions for labor analgesia: a systematic review and meta-analysis. Anesth Analg. 2013; 116(1):133-44.
[17] Onuoha OC. Epidural Analgesia for Labor: Continuous Infusion Versus Programmed Intermittent Bolus. Anesthesiol Clin. 2017; 35(1):1-14.
[18] Anim-Somuah M, Smyth RM, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011(12):Cd000331.
[19] Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, et al. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev. 2012(3):Cd009234.
[20] Feng SW, Xu SQ, Ma L, Li CJ, Wang X, Yuan HM, et al. Regular intermittent bolus provides similar incidence of maternal fever compared with continuous infusion during epidural labor analgesia. Saudi Med J. 2014; 35(10):1237-42.
[21] Mazouni C, Guidicelli B, Gamerre M, Voiret C, Pellegrin V. Influence of epidural analgesia on labor in mid and late termination of pregnancy: an observational study. Int J Obstet Anesth. 2007;16(4):383-4.
[22] Lim Y, Sia AT, Ocampo C. Automated regular boluses for epidural analgesia: a comparison with continuous infusion. Int J Obstet Anesth. 2005;14(4):305-9.
[23] Lin Y, Li Q, Liu J, Yang R, Liu J. Comparison of continuous epidural infusion and programmed intermittent epidural bolus in labor analgesia. Therapeutics and clinical risk management. 2016; 12:1107-12.
[24] Leone Roberti Maggiore U, Silanos R, Carlevaro S, Gratarola A, Venturini PL, Ferrero S, et al. Programmed intermittent epidural bolus versus continuous epidural infusion for pain relief during termination of pregnancy: a prospective, double-blind, randomized trial. Int J Obstet Anesth. 2016; 25:37-44.
[25] Hogan Q. Distribution of solution in the epidural space: examination by cryomicrotome section. Reg Anesth Pain Med. 2002; 27(2):150-6.
[26] Ueda K, Ueda W, Manabe M. A comparative study of sequential epidural bolus technique and continuous epidural infusion. Anesthesiology. 2005; 103(1):126-9.
IssueVol 7 No 1 (2021): Winter QRcode
SectionResearch Article(s)
Bolus Injecion Continuous Infusion Epidural Analgesia Labor Lidocaine

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Manouchehrian N, Kimiaei Asadi H, Rabiei S, Moradi A, Nosrati M. Comparison of the Effect of Epidural Bolus and Continuous Infusion of Lidocaine %1 on Pain, the Progress of Vaginal Delivery and Motor Function in Labor Epidural Analgesia. Arch Anesth & Crit Care. 2021;7(1):12-18.