Bolus epidural infusion improves spread compared with continuous infusion in a cadaveric porcine spine model

BackgroundThe administration of epidural anesthesia during labor is a common technique used to reduce the pain of childbirth. We sought to compare standard infusion strategies of continuous epidural infusions (CEI) with programmed intermittent epidural bolus (PIEB) to assess the length of spread in terms of vertebral body length. Based on previous clinical data in humans, the PIEB was associated with improved pain control and decreased total dose of local anesthetic. We hypothesized that the PIEB was associated with increased spread when compared with CEI.MethodsThirty female Yorkshire-cross swine cadavers were used to compare three infusion strategies, continuous infusion (CEI) 10 mL/hour programmed continuously, multiple bolus (MB) 2 mL given every 12 min for 10 mL total and 10 mL delivered in a single bolus (SB). Radiographs were used to identify the spread of the radiopaque contrast dye, and a number of vertebral bodies covered were measured to assess spread.ResultsOverall, the CEI had an average spread of 5.6 levels, MB 7.9 and SB 10.4. The differences between SB and MB (p=0.011), SB and CEI (p<0.001) and MB and CEI (p=0.028) were all found to be significant.ConclusionsWe demonstrated increased spread of epidural contrast with programmed intermittent bolus strategies. This supports previous evidence of improved patient outcomes with PIEB strategy compared with CEI, and encourages the use of PIEB in the appropriate patient population.

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Continuous Infusion of a Local Anesthetic Versus Interscalene Block for Postoperative Pain Control After Arthroscopic Shoulder Surgery

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2007.04.008 ◽

2007 ◽

Vol 23 (9) ◽

pp. 1006-1011 ◽

Cited By ~ 44

Author(s):

Darby Webb ◽

Dan Guttmann ◽

Patrick Cawley ◽

James H. Lubowitz

Keyword(s):

Postoperative Pain ◽

Continuous Infusion ◽

Local Anesthetic ◽

Pain Control ◽

Shoulder Surgery ◽

Interscalene Block ◽

Postoperative Pain Control ◽

Arthroscopic Shoulder Surgery

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Pain management in augmentation mammaplasty: a randomized, comparative study of the use of a continuous infusion versus self-administration intermittent bolus of a local anesthetic

Aesthetic Surgery Journal ◽

10.1016/j.asj.2004.09.003 ◽

2004 ◽

Vol 24 (6) ◽

pp. 523-530 ◽

Cited By ~ 12

Author(s):

P PACIK

Keyword(s):

Pain Management ◽

Comparative Study ◽

Continuous Infusion ◽

Local Anesthetic ◽

Augmentation Mammaplasty ◽

Self Administration ◽

Intermittent Bolus

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Comparison of programmed intermittent bolus infusion and continuous infusion for postoperative patient-controlled analgesia with thoracic paravertebral block catheter: a randomized, double-blind, controlled trial

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-000031 ◽

2019 ◽

Vol 44 (2) ◽

pp. 240-245 ◽

Cited By ~ 8

Author(s):

Lulu Chen ◽

Yiquan Wu ◽

Yaoyao Cai ◽

Yingchao Ye ◽

Li Li ◽

...

Keyword(s):

Patient Satisfaction ◽

Continuous Infusion ◽

Local Anesthetic ◽

Lung Resection ◽

Paravertebral Block ◽

Patient Controlled Analgesia ◽

Double Blind ◽

Bolus Infusion ◽

Intermittent Bolus ◽

Video Assisted

Background and objectivesIn this randomized, double-blind, controlled study, we hypothesized that programmed intermittent bolus infusion (PIBI) of local anesthetic for continuous paravertebral block (PVB), combined with patient-controlled analgesia (PCA), provided better pain control, better patient satisfaction, and decreased in local anesthetic consumption when compared with a continuous infusion (CI) combined with PCA, after video-assisted thoracoscopic unilateral lung resection surgery.MethodsPreoperatively, patients undergoing video-assisted thoracoscopic unilateral lung resection surgery received ipsilateral paravertebral catheters inserted at the level of thoracic vertebrae 4 and 5. All the subjects received an initial bolus of 15 mL 0.375% ropivacaine via the catheters. Subjects were randomized to receive 0.2 % ropivacaine 8 mL/h as either PIBI (n=17) or CI (n=17) combined with a PCA pump. The pain scores, frequency of PCA, local anesthetic consumption, patient satisfaction, and the need for rescue analgesia with tramadol were recorded until 48 hours postoperative.ResultsThe numeric rating scale scores in the PIBI group were significantly lower than the CI group at 4, 8, 12 hours and 4, 8, 12, 24 hours postoperatively, at rest, and during coughing, respectively. PCA local anesthetic consumption (30 mg (20–60 mg) vs 120 mg (70–155 mg), p=0.000) and frequency of PCA use over 48 hours (3 (2–6) vs 12 (7–15.5), p=0.000) was lower in the PIBI group as compared with the CI group. Additionally, the PIBI group showed greater patient satisfaction. The need for tramadol rescue was similar in the two groups.ConclusionsIn PVBs, local anesthetic administered as a PIBI in conjunction with PCA provided superior postoperative analgesia to a CI combined with PCA in patients undergoing video-assisted thoracoscopic unilateral lung resection surgery.Clinical trial registrationChiCTR-IOR-17011253.

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Effectiveness of continuous infusion of local anesthetic for pain control after median sternotomy: A single-center retrospective chart review

Perioperative Care and Operating Room Management ◽

10.1016/j.pcorm.2019.100072 ◽

2019 ◽

Vol 15 ◽

pp. 100072

Author(s):

Alexa M. Sassin ◽

Stephanie G. Bird ◽

Shuab Omer ◽

Faisal G. Bakaeen ◽

Ourania Preventza ◽

...

Keyword(s):

Continuous Infusion ◽

Local Anesthetic ◽

Pain Control ◽

Chart Review ◽

Median Sternotomy ◽

Retrospective Chart Review ◽

Single Center

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Intermittent bolus versus continuous infusion techniques for local anesthetic delivery in peripheral and truncal nerve analgesia: the current state of evidence

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2018-100082 ◽

2019 ◽

Vol 44 (4) ◽

pp. 447-451 ◽

Cited By ~ 4

Author(s):

Ram Jagannathan ◽

Adam D Niesen ◽

Ryan S D'Souza ◽

Rebecca L Johnson

Keyword(s):

Patient Satisfaction ◽

Adverse Events ◽

Randomized Controlled Trials ◽

Continuous Infusion ◽

Local Anesthetic ◽

Current Evidence ◽

Cochrane Library ◽

Controlled Trials ◽

Intermittent Bolus ◽

Randomized Controlled

Manually delivered intermittent bolus (MIB) and programmable intermittent bolus (PIB), alternatives to continuous infusion (CI), involve administering a set volume of solution at a set interval of time. The benefits of intermittent bolus techniques in truncal and peripheral nerve blockade (TPNB) are unclear, and studies have largely demonstrated conflicting results. Using MEDLINE, Embase, Google Scholar, and the Cochrane Library, we conducted an evidenced-based review of published randomized controlled trials comparing intermittent bolus and CI methods in TPNB. In total, 13 randomized controlled trials were identified and evaluated. Outcomes data addressed in these studies included assessments of pain, opioid and local anesthetic consumption, patient satisfaction, adverse events, and physical therapy metrics. The overall quality of current evidence was found to be low given the small sample sizes, heterogeneity of data, and the variations in intermittent bolus techniques between studies. At this time, we found limited supportive data to endorse MIB or PIB over CI in TPNB. While unable to provide data-driven conclusions for local anesthetic delivery methods at this time, we propose that future studies and quantitative analysis between techniques should be on an anatomic, site-specific basis, with greater focus on evaluation of opioid use, adverse events, patient satisfaction, and rehabilitative metrics.

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A prospective, randomized study of pain control management using continuous infusion of local anesthetic following thoracotomy

European Journal of Anaesthesiology ◽

10.1097/00003643-200606001-00807 ◽

2006 ◽

Vol 23 (Supplement 37) ◽

pp. 225

Author(s):

N. Anastasiou ◽

D. Zachilas ◽

G. Papavasiliou ◽

S. Malagaris ◽

V. Agoritsa ◽

...

Keyword(s):

Continuous Infusion ◽

Local Anesthetic ◽

Pain Control ◽

Randomized Study ◽

Prospective Randomized Study ◽

Control Management

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Programmed Intermittent Bolus Versus Continuous Infusion for Epidural Analgesia in Abdominal Surgery

Case Medical Research ◽

10.31525/ct1-nct04254523 ◽

2020 ◽

Author(s):

Keyword(s):

Abdominal Surgery ◽

Epidural Analgesia ◽

Continuous Infusion ◽

Intermittent Bolus

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Comparison of the Effect of Lidocaine versus a Lidocaine-Bupivacaine Combination in a Periprostatic Nerve Block Undergoing Transrectal Ultrasound-Guided Prostate Biopsy: A Double-Blind Randomized Controlled Trial

Current Urology ◽

10.1159/000447132 ◽

2015 ◽

Vol 9 (3) ◽

pp. 153-158 ◽

Cited By ~ 1

Author(s):

Ali H. Yilmaz ◽

Elif Ziypak ◽

Tevfik Ziypak ◽

Mehmet Aksoy ◽

Senol Adanur ◽

...

Keyword(s):

Nerve Block ◽

Local Anesthetic ◽

Pain Control ◽

Controlled Trial ◽

Late Phase ◽

Patient Comfort ◽

Double Blind ◽

Vas Scores ◽

Long Acting ◽

Periprostatic Nerve Block

Introduction: To determine whether a combination of the long acting local anesthetic, bupivacaine, and lidocaine is better than lidocaine alone in the long-term pain control, which is a short-acting anesthetic. Materials and Methods: In group 1, periprostatic nerve block was applied to both neurovascular areas with 2% lidocaine (5 ml) in an isotonic solution (5 ml). In group 2, the combination of 2% lidocaine (5 ml) and 5mg/ml bupivacaine (5 ml) was used for the PPNB. Results: In the first 30 minutes the mean VAS scores of groups 1 and 2 were 2.1 ± 0.2 and 1.2 ± 0.1, respectively (p = 0.002). VAS scores of group II determined at 1, 2, 4, 6, and 8 hours after the biopsy were significantly lower since it was (p < 0.05). Conclusion: While periprostatic nerve block for late phase pain control, applying a combination of a long-acting local anesthetic, such as bupivacaine, is effective in terms of pain control and patient comfort.

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