Randomized controlled trials comparing intermittent bolus with continuous infusion techniques in peripheral nerve blockade
| Study, year | Surgical intervention | Block type, location, technique, n | Orifices in perineural catheter | Bolus during placement | PIB technique | Type of intermittent bolus | Continuous technique | Summary of results |
| Lower extremity blockade | ||||||||
| Taboada et al,4
2008 | Hallux valgus surgery | Preoperative, popliteal, NS, 44 | Single | Mepi 1.5% 30 mL | Levobupi 0.125% 5 mL bolus, every 1 hour | Programmable pump (CADD) | Levobupi 0.125% 5 mL/hour | Reduction in pain score in PIB group at 6, 8, and 12 hours postoperatively; no difference at 24 hours in quality of blockade and in use of rescue medication. |
| Taboada et al,5 2009 | Hallux valgus surgery | Preoperative, popliteal, NS, 50 | Single | Mepi 1.5% 30 mL | Levobupi 0.125% 5 mL bolus, every 1 hour, 3 mL PRN bolus (every 15 min lockout, max 2 doses/hour) | Programmable pump (CADD) | Levobupi 0.125% 5 mL/hour 3 mL PRN bolus (every 15 min lockout, max 2 doses/hour) | Decreased local anesthetic consumption/dose request from PCA in PIB group; no difference in pain scores, patient satisfaction, quality of block, and use of rescue medication up to 24 hours postoperatively. |
| Hillegass et al,6 2013 | Total knee arthroplasty | Preoperative, femoral, USG+NS, 45 | Single | Ropi 0.5% 20 mL | Ropi 0.2% 5 mL bolus, every 30 min, 0.1 mL/hour basal rate | Programmable pump (CADD) | Ropi 0.2% 10.1 mL/hour | Intravenous PCA usage was reduced throughout analysis; pain scores lower in PIB group in the afternoon of POD 1; no difference in narcotic requirements, patient satisfaction, length of stay, and opioid adverse effects up to morning of POD 2. |
| Thapa et al,7 2016 | ACL reconstruction | Postoperative, adductor canal, USG, 50 | UK | Not given | Ropi 0.5% 15 mL bolus, every 6 hours | Programmable pump (Medima S-PCA) | Ropi 0.5% 2.5 mL/hour | Mean VAS score at rest decreased at 4, 6, 8, and 12 hours postoperatively; on flexion decreased at 4, 6, 8, 12, and 24 hours postoperatively; morphine consumption decreased in PIB group up to 24 hours postoperatively. |
| Wang et al,8 2016 | Total hip arthroplasty | Preoperative, fascia iliaca, USG, 60 | UK | Ropi 0.2% 40 mL | Ropi 0.2% 10 mL bolus, every 1 hour | Programmable pump (UK type) | Ropi 0.2% 10 mL/hour | Pain scores at rest and in motion and opioid usage/adverse effects lower at 8, 12, 24, and 36 hours postoperatively; patient satisfaction higher in PIB group at 48 hours postoperatively. |
| Jæger et al,9 2017 | Total knee arthroplasty | Preoperatively, adductor canal, USG, 107 | Multiple | Ligno 1% 10 mL | Ropi 0.2% 21 mL bolus, every 3 hours | Programmable pump (CADD) | Ropi 0.2% 7 mL/hour | Patients in PIB group had improved quad sparing on POD 2; no difference in pain scores, mobility, ambulation, and opioid consumption up to POD 2. |
| Upper extremity blockade | ||||||||
| Mezzatesta et al,10 1997 | Upper limb reconstruction microsurgery | Preoperative, axillary, NS, 20 | Multiple | 1.5% Lido+epi (1:200K) up to 7 mg/kg, then at 2 hours, 0.5% bupi+epi 2 mg/kg | Bupi 0.25%+epi (1:200K) 0.25 mg/kg, every 1 hour | Manual | Bupi 0.25%+epi 0.25 mg/kg/hour | Plasma concentrations of bupi decreased in MIB group; no difference in pain scores, degree of motor blockade, or narcotic requirements up to 38 hours postoperatively. |
| Hamdani et al,11
2014 | Shoulder surgery | Preoperatively, interscalene, NS+USG, 101 | Single | Ropi 0.5%+lido 1% (1:1) 20 mL | Ropi 0.2% 4 mL bolus, every 1 hour 5 mL PRN bolus (every 30 min lockout) | Programmable pump (GemStar) | Ropi 0.2% 4 mL/hour 5 mL PRN bolus (every 30 min lockout) | No difference in local anesthetic consumption, use of PRN bolus, pain scores, rescue analgesia, adverse events, or patient satisfaction in PIB group up to 48 hours postoperatively. |
| Oxlund et al,12 2018 | Major shoulder surgery | Preoperative, interscalene, USG, 57 | Multiple | Ropi 0.5% 20 mL | Ropi 0.2% 8 mL bolus, every 2 hours 2 mL PRN bolus (every 30 min lockout) | Programmable pump (CADD) | Ropi 0.2% 4 mL/hour (every 30 min lockout) | More hoarseness, less force in coughing, and less total ropi consumption in PIB group throughout 48 hours postoperatively; no difference in VAS score or opioid usage. |
| Paravertebral blockade | ||||||||
| Català,14 1996 | Thoracotomy for lobectomy or wedge resection | Intraoperative, PVB landmark, confirmed by fluoroscopy, 30 | UK | Bupi 0.375%+epi (1:200K) 15 mL (CI group) | Bupi 0.375%+epi (1:200K) 20 mL bolus, every 6 hours | Manual | Bupi 0.25%+epi (1:200K) 5 mL/hour | VAS scores higher in MIB group at rest and on movement at 4, 10, 20, and 48 hours. No differences in rescue analgesia, pinprick level, or hemodynamic measurements. |
| Fibla,13
2015 | Anterior and posterolateral thoracotomy | Intraoperative, PVB, surgical placement, 80 | UK | Levobupi 0.5% 20 mL | Levobupi 0.5% bolus, every 6 hours (total, 300 mg/day) | Manual | Levobupi 0.25% 5 mL/hour (total, 300 mg/day) | VAS score slightly lower in MIB group at 48 and 72 hours; no difference in mean pain score and need for rescue analgesia up to 72 hours postoperatively. |
| Truncal blockade | ||||||||
| Rao Kadam et al,15 2017 | Elective abdominal surgery | Postoperative, TAP (bilateral), USG, 20 | UK | Ropi 0.5% 20 mL per catheter | Ropi 0.2% 20 mL bolus, every 8 hours per catheter | Manual | Ropi 0.2% 8 mL/hour | MIB group more cost-effective (drug pump not used); no difference in duration of block, length of stay, pain scores at rest/with cough, patient satisfaction, or opioid use up to 48 hours postoperatively. |
| Holmes et al,16
2017 | Elective abdominal surgery | Postoperative, TAP (unilateral and bilateral), USG or surgical placement, 120 | Multiple | Ropi 0.2% 20 mL per catheter | Ropi 0.2% 40 mL bolus, every 6 hours per catheter, doses halved if bilateral catheters or if patient <55 kg | Manual | Ropi 0.2% 10 mL/hour, doses halved if bilateral catheters or if patient <55 kg | More rapid recovery in DEMMI mobility scores; no difference in respiratory function, pain scores, length of stay, analgesic consumption, postoperative nausea and vomiting, and patient satisfaction with analgesia. |
ACL, anterior cruciate ligament; bupi, bupivacaine; CI, continuous infusion; DEMMI, de Morton Mobility Index; epi, epinephrine; levobupi, levobupivacaine; lido, lidocaine; ligno, lignocaine; max, maximum; mepi, mepivacaine; MIB, manually delivered intermittent bolus; NS, nerve stimulation; PCA, patient-controlled analgesia; PIB, programmable intermittent bolus; POD, postoperative day; PRN, as needed; PVB, paravertebral block; TAP, transversus abdominis plane; UK, unknown; USG, ultrasound guidance; VAS, Visual Analog Scale; quad, quadriceps muscle; ropi, ropivacaine.