Comparison of programmed intermittent epidural bolus and continuous epidural infusion for post-operative analgesia after major abdominal surgery: A randomized controlled trial

Su, Po-Yi Paul; Peniche, Alec; Clelland, Elle; Ladd, Michael; Delgado, A; Chen, Lee‐lynn; Siegmueller, Claas; Latronica, Mark; Naidu, Ramana; Aleshi, Pedram; Behrends, Matthias

doi:10.1016/j.jclinane.2020.109850

Cited by 5 publications

(9 citation statements)

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“…In addition, there were no differences in the doses of other non-opioid analgesics between the two groups at each time point. These results are consistent with previously published data showing that both PIEB and CEI epidural analgesia provided equally efficacious postoperative analgesia after major abdominal surgery [8]. Theoretically, because of the larger volume delivered with a bolus, PIEB techniques could provide superior analgesia through more extensive distribution of the epidural drug compared to that with continuous infusion [21].…”

Section: Discussionsupporting

confidence: 92%

“…In thoracic surgery, PIEB reduced local anesthetic consumption but resulted in frequent hypotension [20]. Previous studies in abdominal surgery included various types of surgeries such as gynecology, upper and lower abdominal surgery; thus, the pattern of pain and level of insertion of the epidural catheter varied accordingly [7,8]. However, our study focused on major upper abdominal surgery only; consequently, our results are more reliable and reproducible in upper abdominal surgery compared to those of previous studies.…”

Section: Discussionmentioning

confidence: 69%

“…However, because of different pain entities and the target spinal level in major abdominal surgery compared with labor analgesia, the clinical application of PIEB in abdominal surgery might be limited. Few studies have compared the use of PIEB versus CEI after major abdominal surgery, [7,8] and two studies showed inconsistent postoperative outcomes. One study showing the difference between the two groups reported that the PCEA bolus needs were decreased in the PIEB group.…”

Section: Introductionmentioning

confidence: 99%

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Programmed Intermittent Epidural Bolus versus Continuous Epidural Infusion in Major Upper Abdominal Surgery: A Retrospective Comparative Study

Kim

Lee

Kwon

et al. 2021

JCM

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Although recent evidence shows that the programmed intermittent epidural bolus can provide improved analgesia compared to continuous epidural infusion during labor, its usefulness in major upper abdominal surgery remains unclear. We evaluated the effect of programmed intermittent epidural bolus versus continuous epidural infusion on the consumption of postoperative rescue opioids, pain intensity, and consumption of local anesthetic by retrospective analysis of data of patients who underwent major upper abdominal surgery under ultrasound-assisted thoracic epidural analgesia between July 2018 and October 2020. The primary outcome was total opioid consumption up to 72 h after surgery. The data of postoperative pain scores, epidural local anesthetic consumption, and adverse events from 193 patients were analyzed (continuous epidural infusion: n = 124, programmed intermittent epidural bolus: n = 69). There was no significant difference in the rescue opioid consumption in the 72 h postoperative period between the groups (33.3 mg [20.0–43.3] vs. 28.3 mg [18.3–43.3], p = 0.375). There were also no significant differences in the pain scores, epidural local anesthetic consumption, and incidence of adverse events. Our findings suggest that the quality of postoperative analgesia and safety following major upper abdominal surgery were comparable between the groups. However, the use of programmed intermittent epidural bolus requires further evaluation.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

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Programmed Intermittent Epidural Bolus versus Continuous Epidural Infusion in Major Upper Abdominal Surgery: A Retrospective Comparative Study

Kim

Lee

Kwon

et al. 2021

JCM

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“…Recently, PIEB was reported to be used for incision pain management in surgical patients in previous studies. 30–33 We also found that PIEB provided more effective post-cesarean incision pain relief. These findings were similar to the findings reported by previously.…”

Section: Discussionmentioning

confidence: 57%

“…These findings were similar to the findings reported by previously. 33 In contrast, Su et al 30 found that the average pain severity after major abdominal surgery was not different between PIEB and CEI groups. This was likely due to that all subjects received a postoperative multimodal analgesic regimen, which might mask the advantages of PIEB.…”

Section: Discussionmentioning

confidence: 90%

Programmed Intermittent Epidural Bolus in Comparison with Continuous Epidural Infusion for Uterine Contraction Pain Relief After Cesarean Section: A Randomized, Double-Blind Clinical Trial

Mo¹,

Zhao²,

Chen³

et al. 2022

DDDT

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Purpose Programmed intermittent epidural bolus (PIEB) was reported to provide superior maintenance of labour analgesia with better pain relief and less motor block than continuous epidural infusion (CEI). Whether this is also evident for uterine contraction pain relief after cesarean section remains unknown. Patients and Methods Parturients scheduled for cesarean section were recruited for the study. At the end of the surgery, after a similar epidural loading dose given, patients received either PIEB (6 mL·h −1 ) or CEI (6 mL·h −1 ) of 0.1% ropivacaine. The primary outcome was the uterine contraction pain assessed with visual analog scale (VAS-U) at the postoperative 36 h. Secondary outcomes included incision pain at the rest (VAS-R) and in the movement-evoked (VAS-P), and lower extremity motor block (defined as Bromage score > 0). The whole profile of VAS scores between groups was analyzed using linear mixed model. When significant differences were found, the pairwise comparison was done with the Mann Whitney U -test followed by Bonferroni correction. Results One hundred and twenty parturients were studied (PIEB, 60; CEI, 60). VAS-U at the postoperative 36 h in the PIEB group was lower than in the CEI group (Bonferroni-adjusted P < 0.01). The linear mixed model indicated that VAS-U, VAS-R and VAS-P were lower in the PIEB group compared with the CEI group (all P < 0.01). Motor block was higher in the CEI group than in the PIEB group during the study period except 2 h (all P < 0.05). No differences of adverse events such as hypotension and urinary retention were observed between the two groups. Conclusion Programmed intermittent epidural bolus provides more effective uterine contraction and incision pain relief and less motor block after cesarean section than continuous epidural infusion without an increased risk of urinary retention and blood pressure instability.

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Programmed intermittent epidural bolus in parturients

Wang

Zhang

et al. 2022

Medicine

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Background: To evaluate the efficacy and safety of programmed intermittent epidural bolus (PIEB) in parturients Methods: The PubMed, Embase, and the Cochrane Library (from inception to July 2021) were searched for identification of randomized placebo-controlled trials in which PIEB was applied in parturients. The outcomes were the effect of analgesia, satisfaction score, mode of delivery, duration of labor, neonatal condition, and adverse events. The pooled odds ratios (OR), weighted mean difference (WMD), and 95% confidence intervals (CIs) were calculated using random-and fixed-effects models.Results: PIEB was found to be associated with decreased total consumption of ropivacaine (WMD = À15.83, 95% CI: À19.06 to À12.60, P < .00001; I 2 = 61%; P for heterogeneity = .04), total consumption of sufentanil (WMD = À4.93, 95% CI: À6.87 to 2.98, P < .00001; I 2 = 68%; P for heterogeneity = .05), numbers of patients who require patient-controlled epidural analgesia bolus (OR = 0.27, 95% CI: 0.14-0.51, P < .0001; I 2 = 65%; P for heterogeneity = .01), the number of attempts (WMD = À4.12, 95% CI: À7.21 to À1.04, P = .009; I 2 = 100%; P for heterogeneity < .00001), rate of breakthrough pain (OR = 0.47, 95% CI: 0.28-0.80, P = .005; I 2 = 47%; P for heterogeneity = .09). Eight studies focus on the duration of analgesia. After by meta-analysis, we found that the pain visual analogue scale (VAS) score at 30 minutes, 2 hours, 4 hours, and 5 hours in PIEB group was significantly lower when compared with control group, (WMD = À0.15, 95% CI: À0.26 to À0.04, P = .006; I 2 = 0%; P for heterogeneity = .64), (WMD = À0.79, 95% CI: À1.32 to 0.25, P = .004; I 2 = 97%; P for heterogeneity < .00001), (WMD = À1.00, 95% CI: À1.08 to À0.91, P < .00001; I 2 = 0%; P for heterogeneity = .67), (WMD = À1.81, 95% CI: À3.23 to À0.39, P = .01; I 2 = 98%; P for heterogeneity < .00001), respectively. Nineteen studies discussed the mode of delivery between 2 groups. The results suggest that the rate of normal delivery is significantly higher in PIEB group compared with control group (OR = 1.37, 95% CI: 1.08-1.75, P = .01). The time of first and second stage of labor are significantly shorter in PIEB group compared with control group, the result is (WMD = À10.52, 95% CI: À14.74 to 4.76, P < .00001; I 2 = 0%; P for heterogeneity = .86), (WMD = À1.48, 95% CI: À2.26 to À0.69, P = .0002; I 2 = 35%; P for heterogeneity = .10), respectively. Thirteen studies concerned the satisfaction score of patients. The satisfaction score of patients in the PIEB group was significantly higher when compared with control group (WMD = 0.91, 95% CI: 0.42-1.39, P = .0003; I 2 = 98%; P for heterogeneity < .00001). The Apgar score at 1, 5 minutes in PIEB group are significantly higher (WMD = 0.07, 95% CI: 0.02-0.13 P = .007; I 2 = 55%; P for heterogeneity = .04), (WMD = À0.08, 95% CI: À0.12 to À0.05, P < .00001; I 2 = 21%; P for heterogeneity = .27), respectively.Conclusions: PIEB is a good alternative for labor analgesia with better analgesic effect, maternal and infant outcome.A...

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Comparison of programmed intermittent epidural bolus and continuous epidural infusion for post-operative analgesia after major abdominal surgery: A randomized controlled trial

Cited by 5 publications

References 14 publications

Programmed Intermittent Epidural Bolus versus Continuous Epidural Infusion in Major Upper Abdominal Surgery: A Retrospective Comparative Study

Programmed Intermittent Epidural Bolus versus Continuous Epidural Infusion in Major Upper Abdominal Surgery: A Retrospective Comparative Study

Programmed Intermittent Epidural Bolus in Comparison with Continuous Epidural Infusion for Uterine Contraction Pain Relief After Cesarean Section: A Randomized, Double-Blind Clinical Trial

Programmed intermittent epidural bolus in parturients

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