{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T06:39:20Z","timestamp":1765262360291,"version":"3.46.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aimed to evaluate the effective programmed intermittent epidural bolus (PIEB) volume and the efficacy of dural puncture epidural (DPE) for labor analgesia in patients with gestational hypertension (GH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fifty primiparous women with GH, aged 22\u201340\u202fyears and classified as American Society of Anesthesiologists physical status II, scheduled for DPE labor analgesia were included. A biased-coin up-and-down sequential method was used to determine bolus volumes (7\u201312\u202fmL). The first patient received 7\u202fmL, with subsequent adjustments based on the need for rescue analgesia within 6\u202fh of initiation or full cervical dilation. The truncated Dixon and Mood method and isotonic regression analysis were employed to calculate the 90% effective PIEB volume (EV90) and 95% confidence interval (CI). Recorded parameters included maximum sensory and motor blockade scores, mean arterial pressure, adverse events, and neonatal outcomes (umbilical artery pH, Apgar scores at 1 and 5\u202fmin).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The EV90 was 9.82 (95% CI: 9.41\u201310.23) mL using the truncated Dixon and Mood method and 9.95 (95% CI: 9.52\u201310.38) mL using isotonic regression. The incidence of sensory blockade \u2265T6 increased with higher volumes: 0% (7\u20139\u202fmL), 13.33% (10\u202fmL), 25.00% (11\u202fmL), and 60.00% (12\u202fmL). In the 12\u202fmL group, one case of Bromage grade 1 motor blockade (recovered within 6\u202fh), one of fetal bradycardia (resolved after maternal repositioning), and two cases of hypotension not requiring treatment were observed. No significant intergroup differences were detected in the duration of the first or second stage of labor or in the use of antihypertensive medications (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;gt;\u202f0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For patients with GH receiving DPE with PIEB (40-min interval; 0.08% ropivacaine + 0.3\u202f\u03bcg\/mL sufentanil), the EV90 was 9.89\u202fmL. This regimen significantly reduced the risk of excessive sensory block and hypotension while ensuring effective analgesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>www.chictr.org.cn<\/jats:ext-link>\n                      , identifier ChiCTR2500099107.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1719334","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T06:30:07Z","timestamp":1765261807000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimal programmed intermittent epidural bolus volume for dural puncture epidural labor analgesia in patients with gestational hypertension: a biased-coin up-and-down sequential allocation trial"],"prefix":"10.3389","volume":"12","author":[{"given":"Binghui","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongyang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yancen","family":"Meng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1038\/s41574-022-00734-y","article-title":"A global view of hypertensive disorders and diabetes mellitus during 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bupivacaine 0.125% with fentanyl 2 \u03bcg\u00b7mL-1","volume":"66","author":"Bittencourt","year":"2019","journal-title":"Can J Anaesth"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1111\/j.0006-341x.2002.00171.x","article-title":"Dose finding using the biased coin up-and-down design and isotonic regression","volume":"58","author":"Stylianou","year":"2002","journal-title":"Biometrics"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1097\/01.anes.0000267514.42592.2a","article-title":"Advances in and limitations of up-and-down methodology: a pr\u00e9cis of clinical use, study design, and dose estimation in anesthesia research","volume":"107","author":"Pace","year":"2007","journal-title":"Anesthesiology"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1646","DOI":"10.1213\/ane.0b013e318184ec14","article-title":"A randomized trial of dural puncture epidural technique compared with the standard epidural technique for labor 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