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已发表论文
基于硬脊膜穿破硬膜外技术的罗哌卡因-右美托咪定间歇硬膜外追加给药用于分娩镇痛的最佳间隔：一项硬币偏倚序贯升降研究
Authors Yin QL, Yu B, Yang ZZ, Li HP, Li X, Kong H
Received 3 November 2025
Accepted for publication 29 January 2026
Published 2 February 2026 Volume 2026:20 576768
DOI https://doi.org/10.2147/DDDT.S576768
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Anastasios Lymperopoulos
Qiao-Li Yin,1,2,* Bin Yu,1,2,* Zi-Zhong Yang,1,2 Hong-Ping Li,1,2 Xue Li,1 Hao Kong1,2
1Department of Anesthesiology, Peking University First Hospital, Beijing, People’s Republic of China; 2Department of Anesthesiology, Peking University First Hospital Ningxia Women and Children’s Hospital, Yinchuan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Hao Kong, Department of Anesthesiology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, 100034, People’s Republic of China, Tel +86 10 83575138, Fax +86 10 66551057, Email konghao2438@126.com; konghao@bjmu.edu.cn
Purpose: This study aimed to establish the 90% effective interval time for programmed intermittent epidural bolus (PIEB) following dural puncture epidural (DPE) analgesia with a dexmedetomidine ropivacaine combination for primiparas in the first stage of labor.
Patients and Methods: This biased coin up and down sequential allocation trial enrolled 40 nulliparous women requesting labor analgesia. After an initial loading dose, analgesia was maintained with PIEB of a fixed volume of 8 mL of the same solution, starting 1 hour later. The initial PIEB interval was set at 60 minutes for the first patient and subsequently adjusted by ± 5 minutes based on the outcome of the previous patient, following the biased-coin design. A successful interval was defined as no requirement for supplemental analgesia. The primary outcome was the 90% effective PIEB interval (ED90) for the first stage of labor. Secondary outcomes included patient satisfaction, the incidence of motor and sensory block, and adverse events.
Results: Isotonic regression analysis estimated the 90% effective PIEB interval as 34.5 min (95% confidence interval: 31.0– 37.0 min). All patients reported a very high level of satisfaction. The incidence of motor block was 10%, while 37.5% of patients achieved the highest sensory block at the T6 level or above. Notably, no cases of excessive sedation, hypotension, or bradycardia.
Conclusion: For DPE labor analgesia using 8 mL of 0.075% ropivacaine combined with 0.4 μg/mL dexmedetomidine, the optimal PIEB interval is approximately 35 min. This interval can reduce breakthrough pain and the need for rescue analgesia. This finding provides a practical, evidence-based reference for optimizing PIEB regimens in clinical labor analgesia, contributing to improved maternal comfort and labor experience while ensuring safety.
Keywords: labor analgesia, dexmedetomidine, programmed intermittent epidural bolus, dural puncture epidural, time interval
1Department of Anesthesiology, Peking University First Hospital, Beijing, People’s Republic of China; 2Department of Anesthesiology, Peking University First Hospital Ningxia Women and Children’s Hospital, Yinchuan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Hao Kong, Department of Anesthesiology, Peking University First Hospital, No. 8 Xishiku Street, Beijing, 100034, People’s Republic of China, Tel +86 10 83575138, Fax +86 10 66551057, Email konghao2438@126.com; konghao@bjmu.edu.cn
Purpose: This study aimed to establish the 90% effective interval time for programmed intermittent epidural bolus (PIEB) following dural puncture epidural (DPE) analgesia with a dexmedetomidine ropivacaine combination for primiparas in the first stage of labor.
Patients and Methods: This biased coin up and down sequential allocation trial enrolled 40 nulliparous women requesting labor analgesia. After an initial loading dose, analgesia was maintained with PIEB of a fixed volume of 8 mL of the same solution, starting 1 hour later. The initial PIEB interval was set at 60 minutes for the first patient and subsequently adjusted by ± 5 minutes based on the outcome of the previous patient, following the biased-coin design. A successful interval was defined as no requirement for supplemental analgesia. The primary outcome was the 90% effective PIEB interval (ED90) for the first stage of labor. Secondary outcomes included patient satisfaction, the incidence of motor and sensory block, and adverse events.
Results: Isotonic regression analysis estimated the 90% effective PIEB interval as 34.5 min (95% confidence interval: 31.0– 37.0 min). All patients reported a very high level of satisfaction. The incidence of motor block was 10%, while 37.5% of patients achieved the highest sensory block at the T6 level or above. Notably, no cases of excessive sedation, hypotension, or bradycardia.
Conclusion: For DPE labor analgesia using 8 mL of 0.075% ropivacaine combined with 0.4 μg/mL dexmedetomidine, the optimal PIEB interval is approximately 35 min. This interval can reduce breakthrough pain and the need for rescue analgesia. This finding provides a practical, evidence-based reference for optimizing PIEB regimens in clinical labor analgesia, contributing to improved maternal comfort and labor experience while ensuring safety.
Keywords: labor analgesia, dexmedetomidine, programmed intermittent epidural bolus, dural puncture epidural, time interval