Programmed intermittent epidural bolus versus continuous epidural infusion for postoperative analgesia after major abdominal and gynecological cancer surgery: a randomized, triple-blinded clinical trial

BackgroundContinuous epidural infusion (CEI) is the standard application setting for epidural infusion. A new mode, the programmed intermittent epidural bolus (PIEB) technique, showed reduced local anesthetic (LA) consumption and improved analgesia in obstetric analgesia. Goal of this trial was to evaluate the effects of PIEB versus CEI [combined with patient-controlled bolus (PCEA)] on LA consumption and pain scorings in major abdominal cancer surgery.MethodsFollowing ethical approval, patients scheduled for major abdominal cancer surgery under general anesthesia in combination with epidural analgesia were randomized to receive either a PIEB mode of 6mL/h or a CEI mode set at 6mL/h of ropivacaine 0.2%, both combined with a PCEA mode set at a 4mL bolus. LA consumptions and pain scorings were documented until the second postoperative evening.ResultsEighty-four datasets were analyzed (CEI: n=40, PIEB: n=44). Regarding the primary endpoint, cumulative LA PCEA bolus volumes until day 2 differed significantly between the groups [PIEB 10mL (2-28mL) versus CEI, 28mL (12-64mL), median (25th-75th percentiles), p=0.002]. Overall, LA consumption volumes were significantly lower in the PIEB group versus in the CEI group [PIEB: 329mL (291-341mL) vs. CEI: 350mL (327-381mL), p=0.003]. Pain scores were comparable at each time point.ConclusionsThis trial demonstrates reduced needs for PCEA bolus in the PIEB group. There were no clinically relevant benefits regarding morphine consumption, pain scorings, or other secondary outcome parameters.Trial registrationThis study has been registered retrospectively in the ClinicalTrials.gov registry (NCT03378804), date of registration: December, 20th 2017.