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(Anaesthesia. 2023;78(9):1129–1138)Neuraxial labor analgesia is a well-established and effective method for managing pain during labor. The initiation of analgesia through epidural or combined spinal-epidural methods can be followed by various maintenance techniques, including continuous epidural infusion, manual intermittent boluses, patient-controlled epidural analgesia (PCEA), programmed intermittent epidural bolus (PIEB), or a combination of these approaches. Adding PCEA to a continuous infusion was long-favored, demonstrating benefits such as reduced breakthrough pain incidents, lower local anesthetic consumption without compromising efficacy, and heightened patient satisfaction compared with continuous epidural infusion.

(Anaesthesia. 2021;76:665–680. doi: 10.1111/anae.15339. Epub December 28, 2020)Although postoperative pain from cesarean delivery (CD) can be severe and cause adverse maternal outcomes, it is often underestimated and undertreated. The PROSPECT working group is a multidisciplinary team of surgeons and anesthetists that collaborated to systematically review the current literature and provide evidence-based guidelines to optimize post-delivery analgesia for elective CDs. The PROSPECT group deemed an update from the last systematic review necessary to incorporate more recent approaches, including quadratus lumborum blocks.

(Anaesthesia. 2020;75:1635–1642)Many institutions use patient-controlled epidural analgesia (PCEA) for pain relief during labor; however, programmed intermittent epidural bolus+PCEA (PIEB) has emerged as possibly superior to PCEA alone. PIEB has been found to provide pain relief with less local anesthetic, fewer or later patient-administered boluses and less motor block than PCEA strategies. PIEB has also been shown to reduce the need for instrumental vaginal delivery and manual bolus intervention by the anesthetist, and to improve maternal satisfaction. To date, there are no known studies comparing PIEB with PCEA without background infusion. The aim of this study is to compare the incidence of breakthrough pain with PIEB and PCEA.