Adoption of New Scoring System (PConPUP) for the Timing of Epidural Bolus Dose during the Second Stage of Labour

Afsana  Ferdousy; Kazi Mahzabin  Arin; Mohammad Shafiqul  Islam; Md Mostafa  Kamal; Dilip Kumar  Bhowmick; AKM  Akhtaruzzaman

doi:10.62848/bjpain.v5i1.8380

Authors

Afsana Ferdousy Specialist, Department of Anaesthesia, BRB Hospital Limited, Panthapath, Dhaka.
Kazi Mahzabin Arin Assistant Professor, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka. https://orcid.org/0009-0004-0064-3847
Mohammad Shafiqul Islam Professor, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka https://orcid.org/0000-0003-3443-7828
Md Mostafa Kamal Assistant Professor, (OSD) DGHS, MOHFW & Clinical Fellow, Pain Medicine, Bangladesh Medical University, Dhaka. https://orcid.org/0000-0002-4665-1904
Dilip Kumar Bhowmick Professor, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka. https://orcid.org/0000-0002-8258-5000
AKM Akhtaruzzaman Professor, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka. https://orcid.org/0000-0002-2427-1863

DOI:

https://doi.org/10.62848/bjpain.v5i1.8380

Keywords:

Labour analgesia, Epidural bolus, Second stage, New scoring system (PConPUP)

Abstract

Background: Labour epidural analgesia is considered the gold standard technique for relieving labour pain. The impact of epidural analgesia on the second stage of labour considering the progress and outcome is a great concern. The timing of the epidural bolus during the second stage is controversial. This study aimed to evaluate the effectiveness of a new three-point scoring system (PConPUP) to determine the timing of epidural bolus at the second stage of labour.
Methods: This observational study was carried out at the Department of Obstetrics and Gynaecology of Bangladesh Medical University (BMU) and Mohammadpur Fertility Services and Training Centre (MFSTC), Dhaka. Parturients aging 19-35 years, full term (> 37weeks), and cervical dilatation ≥4 cm were included. They were received an epidural bolus dose of 12 ml levobupivacaine-fentanyl (0.1%) when at least two major criteria reached score 2 along with rest criteria score 1 or a total score ≥8. The quality of analgesia, mode of delivery, maternal haemodynamics, and APGAR score were documented.
Result: A total of 44 patients were selected for this study. The average age was 24.69 ± 6.39 years, BMI was 24.42 ± 3.61 Kg/m2, and Gestational age was 38.44±0.23 weeks. Before epidural bolus, cervical dilation was 4.68±0.51 cm, pulse 90.0±1.34 beats/min, SBP 121.90±7.83 mmHg, DBP 74.45±6.09 mmHg, fetal heart rate 137.51±3.61 beats/min, and VAS score was 6.97±1.14. After epidural bolus, VAS score was reduced to 2.15±0.25 and no change of haemodynamics was observed. All parturients gave birth through vaginal delivery, only 6 (14%) needed instrumental delivery. APGAR score of the baby at the 1st and 5th minute were good.
Conclusion: This new scoring system (PConPUP) can be used as a tool to determine the timing of epidural bolus during the second stage of labour.