Optimiser l'analgésie obstétricale : intérêts du mode PIEB

Programmed Intermittent Epidural Bolus (PIEB) administration is a new way of providing epidural analgesia during delivery. Boluses of a local anaesthetic solution are systematically administered at programmed intervals in combination with conventional patient-controlled epidural analgesia. Compared to PCEA with continuous infusion, PIEB allows to decrease the cumulated amount of local anaesthetic given to patients, decreases the requirement to complementary analgesia, and improves mothers' satisfaction. Parturients self-administer epidural boluses less commonly, especially during the first stage of delivery. The improvement in pain control is associated with a decrease in motor block especially at the end of delivery with a decrease in the incidence of instrumental delivery. In vitro studies document that the epidural distribution of the local anaesthetic solution is more homogeneous when a single dose is injected at a given rate and pressure. Pain control is better achieved with PIEB compared to epidural continuous infusion. There is no recommendation concerning the size of the bolus and the lock-out interval and further studies are needed to determine these points.