KKH testing new way to reduce pain in childbirth

The smart pump aims to reduce "breakthrough pain" - which occurs when a dose of epidural loses its efficacy and a patient feels pain while waiting for the next dose - by tracking how often patients press a button to release more doses.
The smart pump aims to reduce "breakthrough pain" - which occurs when a dose of epidural loses its efficacy and a patient feels pain while waiting for the next dose - by tracking how often patients press a button to release more doses.PHOTO: KK WOMEN'S AND CHILDREN'S HOSPITAL

Smart epidural pump helps women manage labour pain better, anticipates dosage needed

A new technology being tested at KK Women's and Children's Hospital (KKH) may make childbirth by epidural a less painful process.

Under the technology called Epiva, a smart pump that administers an epidural to women during natural childbirth can help them manage labour pain more effectively.

KKH owns the technology behind this pump, which local medtech company Innovfusion is licensed to build and sell.

More than 200 women have undergone the trial, which targets 3,000 women undergoing their first childbirth.

Preliminary results showed that the percentage of patients who complained of "breakthrough pain" during labour has dropped from 25 per cent to about 6 per cent as a result of the smart pump, said Mr Theodore Tan of Biofactory, a firm helping to incubate Innovfusion.

Epidural is injected into the epidural space of the spinal cord to relieve pain during childbirth.

The smart pump aims to reduce "breakthrough pain" - which occurs when a dose of epidural loses its efficacy and a patient feels pain while waiting for the next dose - by tracking how often women press a button to release doses.

If they press it more often, the machine will know they are feeling more pain, and increase the basal rate of epidural in the next hour. It lowers the dosage if they press the button less often.

Conventional epidural systems are unable to anticipate the rate of epidural needed by the patients.

The new pump can deliver the drug twice as fast, at 200ml per hour, as the conventional epidural pump.

It also helps to manage patients' pain by releasing, for example, 50ml at one go instead of smaller doses every minute over a longer time.

This method has been found by KKH to be more effective in managing pain, said Mr Tan.

This system also improves productivity, he added. "If you have a lot of patients in pain half the time, nurses will be running around managing it. If the pain is better managed, nurses can focus on other aspects of patient care."

Last year, KKH's Department of Women's Anaesthesia administered about 5,000 labour epidurals.

The department's deputy head, Dr Sng Ban Leong, said: "We have received encouraging feedback with good patient satisfaction on the use of the Epiva pump and are currently assessing the feedback. The plan is to implement this technology... some time in the next year."

Currently, there are five pumps - each costing $8,000 - in KKH for the trial, but Mr Tan said 30 more will be added by next year, pending certification approval.

He added that the company plans to approach other hospitals here and overseas to sell these units.

KKH is also using the trial to track other clinical issues, such as whether women with poor epidural response indicates other issues, or whether women who use a higher dosage tend to have increased chances of caesarean labour.

Said Dr Sng: "A previous study conducted at KKH found that the patient's individual pain response may be associated with the way patients demand additional pain medications during epidural pain relief, and also with more difficult labour requiring interventions.

"The trial hopes to provide a more definitive answer to these clinical questions."

A version of this article appeared in the print edition of The Straits Times on December 12, 2015, with the headline 'KKH testing new way to reduce pain in childbirth'. Print Edition | Subscribe