Utility of programmed intermittent bolus infusion modality in peripheral nerve catheters for postoperative pain management – A systematic review and meta-analysis

Background and Aims: Continuous peripheral nerve block catheters deliver prolonged anesthesia or analgesia during the perioperative period and have evolved into established practices. Recent advancements in regional anesthesia aim to improve patient outcomes by reducing morbidity. Despite the use of adjuvants, single injection pain management typically lasts only 16 to 24 hours. Alternatively, continuous infusion (CI) pumps may increase local anesthetic doses, raising the risk of toxicity and opioid use. The newly evaluated programmed intermittent bolus (PIB) pumps show promise for peripheral nerve blocks, yet a Cochrane Library search indicates a gap in research, with only handful of registered trials on this topic. This highlights the need for further investigation and subgroup analyses to strengthen evidence for this modality in pain management. Materials and Methods: In accordance with the PROSPERO registry protocol for this review, we conducted a literature search to evaluate the safety and effectiveness of the PIB pumps in peripheral nerves blocks for postoperative pain management. Our primary outcomes included pain scores, consumption of local anesthetics, morphine, and rescue analgesics, as well as any encountered side effects. Results: There were 25 published randomized controlled trials, meeting the inclusion criteria, comprising 1572 patients, directly comparing PIB and CI, and explaining all the comparatives with rare complications. Despite the ever growing quest to find the ideal postoperative pain management method, there is limited literature and it is insufficient to guide clinical practice. Our study underscores the utility of PIB. Conclusion: PIB proves a better analgesic mode than CI.