An in vitro evaluation of the pressure generated during programmed intermittent epidural bolus injection at varying infusion delivery speeds

Epidural bolus versus continuous epidural infusion analgesia on optic nerve sheath diameter in paediatric patients: A prospective, double-blind, randomised trial

“…In the bolus group, as we expected, the maximum value was observed 10 min after the epidural bolus was administered, rather than immediately afterward. We also expected that the lumbar epidural bolus would result in a greater increase in optic nerve sheath diameter than would continuous infusion because the delivery speed was much faster in the bolus group 12 . However, although the optic nerve sheath diameter rapidly increased in the bolus group, epidural bolus did not cause a greater increase in optic nerve sheath diameter than did infusion.…”

“…Compared with continuous epidural infusion, programmed intermittent epidural bolus can have greater analgesic efficacy and fewer side effects in surgical patients [9][10][11] . However, an epidural bolus may generate relatively higher injection pressure because the delivery speed of a solution through the epidural catheter is directly related to peak pressures 12 . Thus, compared with continuous epidural infusion, pressure changes after programmed intermittent epidural bolus use are more likely to increase epidural pressure and, subsequently, intracranial pressure.…”

Determination of the optimal programmed intermittent epidural bolus volume of bupivacaine 0.0625% with fentanyl 2 μg.ml−1 at a fixed interval of forty minutes: a biased coin up‐and‐down sequential allocation trial

“…One possibility would be the use of a higher concentration of local anaesthetic, which would allow a significant reduction in the PIEB bolus volume while maintaining the same amount of drug. Another option would be the use of different PIEB flow rates, given that previous studies have shown that increased flow rates lead to increased pressure in the epidural catheter and wider spread of local anaesthetic solutions within the epidural space [13,14].…”

An Update on Drugs Used for Lumbosacral Epidural Anesthesia and Analgesia in Dogs

“…However, a recent study showed that an injection velocity of 1 mL min −1 compared with 2 mL min −1 of 0.5% bupivacaine after epidural administration had limited effect on injectate distribution and sensory blockade in anesthetized dogs (33). The effect of epidural drug injection velocity on duration and quality of analgesia is yet to be determined (43). In the authors’ routine, injectate volume is commonly administered over approximately 1 min.…”