Archives of Gynecology and Obstetrics

, Volume 300, Issue 6, pp 1551–1557 | Cite as

Programmed intermittent epidural bolus decreases the incidence of intra-partum fever for labor analgesia in primiparous women: a randomized controlled study

  • Yuru Fan
  • Wenwen Hou
  • Shi Feng
  • Pengyuan Mao
  • Xian Wang
  • Jianan Jiang
  • Hongmei Yuan
  • Xiaofeng Shen
  • Shanwu FengEmail author
  • Ping LiEmail author
Maternal-Fetal Medicine



To evaluate whether programmed intermittent epidural bolus (PIEB) reduces the incidence of maternal intra-partum fever compared with continuous epidural infusion (CEI) during labor.


Parturients were randomized to receive CEI (CEI group) or PIEB (PIEB group) with 10 ml per hour for epidural labor analgesia with 1500 subjects in each group. The maintaining dose of two groups is 0.08% ropivacaine with 0.4 μg/ml sufentanil, with patient-controlled epidural analgesia (PCEA) dose of 5 ml and lockout interval of 30 min. The incidence of maternal fever, pain score, epidural sensory levels, the number and proportion of PCEA demand, anesthetics consumption, satisfaction score, neonatal Apgar scale, and maternal and neonatal side effects were recorded.


It was significantly lower of the incidence of maternal fever beginning at 4 h post-analgesia and continuing until delivery in the PIEB group than the CEI group (4 h: 2.6% vs. 4.2%; 5 h: 7.3% vs. 10.2%; delivery: 5.6% vs. 7.9%; 1 h post-delivery: 3.9% vs. 6.2%; 2 h post-delivery: 2.1 vs. 3.5%; total: 5.8% vs. 8.4% in PIEB and CEI, respectively). Compared with CEI group, pain scores at 3, 4, 5 h post-analgesia and delivery (3 h: 2 [1, 2] vs. 2 [1–3]; 4 h: 2 [2, 3] vs. 3 [2–4]; 5 h: 2 [2, 3] vs. 3 [2–4]; delivery: 3 [2–4] vs. 4 [3, 4] in PIEB and CEI, respectively), the number and proportion of PCEA demand (number: 0.7 ± 0.9 vs. 2.2 ± 1.9; proportion: 42.0% vs. 80.3% in PIEB and CEI, respectively), and anesthetics consumption significantly decreased in the PIEB group (Ropivacaine: 60 ± 13 mg vs. 76 ± 17 mg; Sufentanil: 26 ± 4 mg vs. 32 ± 6 mg in PIEB and CEI, respectively), without severe maternal and neonatal side effects and any difference in neonatal Apgar scale. The epidural sensory levels 2 h post-analgesia (2 h: 8[8, 9] vs. 9[8, 9] in PIEB and CEI) and satisfaction score (9 [9, 10] vs. 7 [6, 7] in PIEB and CEI) were significantly higher in the PIEB group compared with those in the CEI group.


PIEB with 10 ml of 0.08% ropivacaine and 0.4 μg/ml sufentanil hourly provided a lower incidence of intra-partum fever with a better analgesic effect compared with CEI, without any severe maternal and neonatal adverse reactions.


Continuous epidural infusion Intra-partum fever Labor analgesia Programmed intermittent epidural bolus 



The study was supported by grant 81971045 of National Natural Science Foundation of China.

Author contributions

YRF Project development, data collection, WWH manuscript writing, data management, SF manuscript writing, PYM data collection, XW manuscript writing, JNJ data management, HMY data analysis, XFS project development, SWF project development, manuscript writing, PL project development, manuscript writing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Feng SW, Xu SQ, Ma L, Li CJ, Wang X, Yuan HM, Wang FZ, Shen XF, Ding ZN (2014) Regular intermittent bolus provides similar incidence of maternal fever compared with continuous infusion during epidural labor analgesia. Saudi Med J 35:1237–1242PubMedPubMedCentralGoogle Scholar
  2. 2.
    Curtin WM, Katzman PJ, Florescue H, Metlay LA, Ural SH (2015) Intrapartum fever, epidural analgesia and histologic chorioamnionitis. J Perinatol 35:396–400CrossRefGoogle Scholar
  3. 3.
    Douma MR, Stienstra R, Middeldorp JM, Arbous MS, Dahan A (2015) Differences in maternal temperature during labour with remifentanil patient-controlled analgesiaor epidural analgesia: a randomised controlled trial. Int J Obstet Anesth 24:313–322CrossRefGoogle Scholar
  4. 4.
    Sharpe EE, Arendt KW (2017) Epidural labor analgesia and maternal fever. Clin Obstet Gynecol 60:365–374CrossRefGoogle Scholar
  5. 5.
    Wassen MM, Winkens B, Dorssers EM, Marcus MA, Moonen RM, Roumen FJ (2014) Neonatal sepsis is mediated by maternal fever in labour epidural analgesia. J Obstet Gynaecol 34:679–683CrossRefGoogle Scholar
  6. 6.
    Burgess APH, Katz JE, Moretti M, Lakhi N (2017) Risk Factors for intrapartum fever in term gestations and associated maternal and neonatal sequelae. Gynecol Obstet Invest 82:508–516CrossRefGoogle Scholar
  7. 7.
    Petrova A, Demissie K, Rhoads GG, Smulian JC, Marcella S, Ananth CV (2001) Association of maternal fever during labor with neonatal and infant morbidity and mortality. Obstet Gynecol 98:20–27CrossRefGoogle Scholar
  8. 8.
    Sultan P, David AL, Fernando R, Ackland GL (2016) Inflammation and epidural-related maternal fever: proposed mechanisms. Anesth Analg 122:1546–1553CrossRefGoogle Scholar
  9. 9.
    Segal S, Pancaro C, Bonney I, Marchand JE (2017) Noninfectious fever in the near-term pregnant rat induces fetal brain inflammation: a model for the consequences of epidural-associated maternal fever. Anesth Analg 125:2134–2140CrossRefGoogle Scholar
  10. 10.
    Wong CA, Ratliff JT, Sullivan JT, Scavone BM, Toledo P, Mccarthy RJ (2006) A randomized comparison of programmed intermittent epidural bolus with continuous epidural infusion for labor analgesia. Anesth Analg 102:904–909CrossRefGoogle Scholar
  11. 11.
    George RB, Allen TK (2013) Habib AS (2013) Intermittent epidural bolus compared with continuous epidural infusions for labor analgesia: a systematic review and meta-analysis. Anesth Analg 116:133–144CrossRefGoogle Scholar
  12. 12.
    Mantha VR, Vallejo MC, Ramesh V, Phelps AL, Ramanathan S (2008) The incidence of maternal fever during labor is less with intermittent than with continuous epidural analgesia: a randomized controlled trial. Int J Obstet Anesth 17:123–129CrossRefGoogle Scholar
  13. 13.
    Salafia CM, Weigl C, Silberman L (1989) The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies. Obstet Gynecol 73:383–389PubMedGoogle Scholar
  14. 14.
    Lieberman E, Lang JM, Frigoletto F Jr, Richardson DK, Ringer SA, Cohen A (1997) Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics 99:415–419CrossRefGoogle Scholar
  15. 15.
    Yancey MK, Zhang J, Schwarz J, Dietrich CS 3rd, Klebanoff M (2001) Labor epidural analgesia and intrapartum maternal hyperthermia. Obstet Gynecol 98:763–770PubMedGoogle Scholar
  16. 16.
    Vinson DC, Thomas R, Kiser T (1993) Association between epidural analgesia during labor and fever. J Fam Pract 36:617–622PubMedGoogle Scholar
  17. 17.
    Philip J, Alexander JM, Sharma SK, Leveno KJ, McIntire DD, Wiley J (1999) Epidural analgesia during labor and maternal fever. Anesthesiology 90:1271–1275CrossRefGoogle Scholar
  18. 18.
    Herbst A, Wølner-Hanssen P, Ingemarsson I (1995) Risk factors for fever in labor. Obstet Gynecol 86:790–794CrossRefGoogle Scholar
  19. 19.
    Dashe JS, Rogers BB, McIntire DD, Leveno KJ (1999) Epidural analgesia and intrapartum fever: placental findings. Obstet Gynecol 93:341–344PubMedGoogle Scholar
  20. 20.
    Ploeckinger B, Ulm MR, Chalubinski K, Gruber W (1995) Epidural anaesthesia in labour: influence on surgical delivery rates, intrapartum fever and blood loss. Gynecol Obstet Invest 39:24–27CrossRefGoogle Scholar
  21. 21.
    Mayer DC, Chescheir NC, Spielman FJ (1997) Increased intrapartum antibiotic administration associated with epidural analgesia in labor. Am J Perinatol 14:83–86CrossRefGoogle Scholar
  22. 22.
    Lucas MJ, Sharma SK, McIntire DD, Wiley J, Elaine Sidawi J, Ramin SM, Leveno KJ, Cunningham GC (2001) A randomized trial of labor analgesia in women with pregnancy-induced hypertension. Am J Obstet Gynecol 185:970–975CrossRefGoogle Scholar
  23. 23.
    Ramin SM, Gambling DR, Lucas MJ, Sharma SK, Sidawi JE, Leveno KJ (1995) Randomized trial of epidural versus intravenous analgesia during labor. Obstet Gynecol 86:783–789CrossRefGoogle Scholar
  24. 24.
    Sharma SK, Alexander JM, Messick G, Bloom SL, McIntire DD, Wiley J, Leveno KJ (2002) Cesarean delivery: a randomized trial of epidural analgesia versus intravenous meperidine analgesia during labor in nulliparous women. Anesthesiology 96:546–551CrossRefGoogle Scholar
  25. 25.
    Sharma SK, Sidawi JE, Ramin SM, Lucas MJ, Leveno KJ, Cunningham FG (1997) Cesarean delivery: a randomized trial of epidural versus patient-controlled meperidine analgesia during labor. Anesthesiology 87:487–494CrossRefGoogle Scholar
  26. 26.
    Kaul B, Vallejo M, Ramanathan S, Mandell G (2001) Epidural labor analgesia and neonatal sepsis evaluation rate: a quality improvement study. Anesth Analg 93:986–990CrossRefGoogle Scholar
  27. 27.
    Glosten B, Savage M, Rooke GA, Brengelmann GL (1998) Epidural anesthesia and the thermoregulatory responses to hyperthermia-preliminary observations in volunteer subjects. Acta Anaesthesiol Scand 42:442–446CrossRefGoogle Scholar
  28. 28.
    Hogan Q (2002) Distribution of solution in the epidural space: examination by cryomicrotome section. Reg Anesth Pain Med 27:150–156PubMedGoogle Scholar
  29. 29.
    Ueda K, Ueda W, Manabe M (2005) A comparative study of sequential epidural bolus technique and continuous epidural infusion. Anesthesiology 103:126–129CrossRefGoogle Scholar
  30. 30.
    Wong CA, Mccarthy RJ, Hewlett B (2011) The Effect of manipulation of the programmed intermittent bolus time interval and injection volume on total drug use for labor epidural analgesia: a randomized controlled trial. Anesth Analg 112:904–911CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Labor and Delivery Room, Nanjing Maternity and Child Health Care HospitalWomen’s Hospital of Nanjing Medical UniversityNanjingChina
  2. 2.Department of Obstetrics, Nanjing Maternity and Child Health Care HospitalWomen’ s Hospital of Nanjing Medical UniversityNanjingChina
  3. 3.Department of Clinical MedicineKangda College of Nanjing Medical UniversityLianyungangChina
  4. 4.Department of Human Resources, Nanjing Maternity and Child Health Care HospitalWomen’ s Hospital of Nanjing Medical UniversityNanjingChina
  5. 5.Department of Anesthesiology, Nanjing Maternity and Child Health Care HospitalWomen’s Hospital of Nanjing Medical UniversityNanjingChina
  6. 6.Operating Room, Nanjing Maternity and Child Health Care HospitalWomen’ s Hospital of Nanjing Medical UniversityNanjingChina
  7. 7.Department of Gynecology, Nanjing Maternity and Child Health Care HospitalWomen’s Hospital of Nanjing Medical UniversityNanjingChina

Personalised recommendations