Automated Boluses and Delayed-Start Timers Prolong Perineural Local Anesthetic Infusions and Analgesia Following Ankle and Wrist Orthopedic Surgery: A Case-Control Series - PubMed (original) (raw)
Automated Boluses and Delayed-Start Timers Prolong Perineural Local Anesthetic Infusions and Analgesia Following Ankle and Wrist Orthopedic Surgery: A Case-Control Series
John J Finneran Iv et al. Med Sci Monit. 2021.
Abstract
BACKGROUND Continuous peripheral nerve blocks can be administered as continuous infusion, patient-controlled boluses, automated boluses, or a combination of these modalities. MATERIAL AND METHODS Ten patients undergoing either ankle (5) or distal radius (5) open reduction and internal fixation received single-injection ropivacaine sciatic nerve block or infraclavicular brachial plexus block and catheter. Infusion pumps were set to begin administering additional ropivacaine 6 h following the initial block as automated boluses supplemented with patient-controlled boluses. RESULTS Patients had similar pain scores when compared to previously published controls; however, local anesthetic consumption was lower in the patients, resulting in increased infusion and analgesia duration by 1 or more days in each group. CONCLUSIONS For infraclavicular and popliteal sciatic catheters, automated boluses may provide a longer duration of analgesia than continuous infusions following painful hand and ankle surgeries, respectively.
Conflict of interest statement
Conflict of interest: John J. Finneran’s institution has received funding and/or product for his research from Epimed, InfuTronix, and SPR Therapeutics. Paola Baskin reports no conflicts. William T. Kent reports no conflicts. Eric R. Hentzen reports no conflicts. Alexandra K. Schwartz is a paid speaker for DePuy Sythes (Raynham, MA) and consultant for Globus Medical (Audubon, PA). Brian M. Ilfeld’s institution has received funding and/or product for his research from Epimed, InfuTronix, and SPR Therapeutics
Figures
Figure 1
Worst, average, and lowest pain scores during the first 4 days following foot/ankle surgery with a popliteal sciatic catheter and ropivacaine administered by either automated boluses or continuous infusion. Data is expressed as median (horizontal bar), 25th to 75th percentile (box), and 10th to 90th percentile (whiskers), and statistics were not applied owing to the small sample size.
Figure 2
Worst, average, and lowest pain scores during the first 3 days following wrist/hand surgery with an infraclavicular brachial plexus catheter and ropivacaine administered by either automated boluses or continuous infusion. Data is expressed as median (horizontal bar), 25th to 75th percentile (box), and 10th to 90th percentile (whiskers), and statistics were not applied owing to the small sample size.
References
- Ilfeld BM. Continuous peripheral nerve blocks. An update of the published evidence and comparison with novel, alternative analgesic modalities. Anesth Analg. 2017;124:308–35. -PubMed
- Taboada M, Rodríguez J, Bermudez M, et al. A “new” automated bolus technique for continuous popliteal block: A prospective, randomized comparison with a continuous infusion technique. Anesth Analg. 2008;107(4):1433–37. -PubMed
- Taboada M, Rodríguez J, Bermudez M, et al. Comparison of continuous infusion versus automated bolus for postoperative patient-controlled analgesia with popliteal sciatic nerve catheters. Anesthesiology. 2009;110:150–54. -PubMed
- Ilfeld BM, Morey TE, Enneking FK. Infraclavicular perineural local anesthetic infusion: A comparison of three dosing regimens for postoperative analgesia. Anesthesiology. 2004;100(2):395–402. -PubMed
- Ilfeld BM, Thannikary LJ, Morey TE, et al. Popliteal sciatic perineural local anesthetic infusion: A comparison of three dosing regimens for postoperative analgesia. Anesthesiology. 2004;101(4):970–77. -PubMed