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

Abstract

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.

Continuous basal infusion versus programmed intermittent bolus for quadratus lumborum block after laparoscopic colorectal surgery: a randomized-controlled, double-blind study

“…For example, Hillegass et al showed preferable effects of PIB for femoral block in pain scores and opioid requirements [18]. Other researchers have shown that PIB for thoracic paravertebral block produced wider dermatomal sensory blockade and improved analgesia [19][20][21]. However, benefits of PIB on abdominal wall blocks have not been apparent [25][26][27].…”

“…Recently, intermittent boluses of local anesthetic have attracted attention due to the development of devices with programmed delivery and have been used to produce wider sensory blockade and better analgesia compared with continuous basal infusion with epidural analgesia for labor [15,16] and some peripheral nerve blocks [17][18][19][20][21]. Since QLB is a fascial compartment block where a large volume of local anesthetics producing a wide spread is preferable, it is reasonable to presume that intermittent boluses contribute to maintaining the range of cutaneous sensory blockade and, thus, result in better analgesia compared with the same volume using continuous basal infusion.…”

Thoracic-paravertebral blocks: comparative anatomical study with different injection techniques and volumes

“…In contrast, the use of coiled catheters reduces the risk of an epidural catheter position 5–8. In a recent study, application of intermittent boli via a catheter was superior to a continuous infusion in terms of the analgesic effect 17…”

A Comparative Study of Automated Pulsed Bolus Versus Continuous Basal Infusion on Distribution of Dye in the Paravertebral Space in a Cadaver

“…However, the clinical evidence to support this hypothesis is currently inconclusive. Chen et al demonstrated that hourly PIB in the thoracic paravertebral catheters for unilateral videoassisted lung resection was superior to CI by decreasing the need for additional patient controlled doses of local anesthesia, reduced pain scores, and improved patient satisfaction [4]. On the contrary, a study by Català et al demonstrated that PIB provided inferior pain control in comparison to a CI in a thoracic PVB catheter, but the pulsed interval was six hours [5].…”