A Randomized Controlled Trial Comparing the Analgesic Efficacy of Programmed Intermittent Bolus vs. Continuous Infusion of Ropivacaine and Fentanyl in Ultrasound-Guided Infraclavicular Brachial Plexus Block for Upper Limb Surgery.

Abstract

Programmed intermittent bolus (PIB) is a novel method of intermittent drug delivery commonly employed in labor epidural analgesia. This study aimed to evaluate the potential benefits of PIB over continuous infusion (CI) for postoperative analgesia following upper limb surgeries distal to the mid-humerus level using ultrasound-guided infraclavicular brachial plexus block (USG-IBPB). The USG-IBPB was performed on a total of 30 patients scheduled for upper limb surgery distal to the mid-humerus level. The patient-controlled regional analgesia pump delivered a combination of 6 mL of 0.2% ropivacaine and 2 μg/mL fentanyl via a perineural catheter as PIB in group I and as a CI in group II. The primary outcome measure was overall drug consumption, and secondary outcomes included pain scores, patient satisfaction, sensory and motor blockade, and adverse effects. The PIB group exhibited significantly lower overall drug consumption (306.20 ± 13.07 mL vs. 323.73 ± 11.79 mL; P = 0.001), a reduced need for patient-controlled analgesia boluses (3.87 ± 2.67 vs. 7.13 ± 2.36; P = 0.001), and higher patient satisfaction (91.93 ± 10.09 vs. 78.67 ± 17.57; P = 0.017) compared to the CI group. Pain scores at rest were significantly lower at the 24-hour mark (P = 0.007), and on movement, lower scores were observed after 1, 24, and 36 hours (P = 0.031, P = 0.031, and P = 0.011, respectively). Sensory block, motor block, and adverse effects were similar between the two groups. PIB demonstrated superior efficacy in postoperative analgesia compared to the CI technique for upper limb surgeries distal to the mid-humerus level. Therefore, PIB may be considered an effective alternative to CI for optimal postoperative pain management.