Programmed Intermittent Bolus Mode

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Nimbus PainPRO post op pain pump

Programmed Intermittent Bolus Mode

Automated Boluses Enhance Anesthetic Spread.

Besides a Continuous Rate and Patient Demand Bolus, Nimbus PainPRO offers the programmed intermittent bolus (PIB) or automated bolus infusion mode. Nimbus PainPRO is the only single-patient-use electronic pump that can infuse all 3 modes in any therapy combination in any of its infusion protocols.

What Can Automated Boluses Do For Your Patients?
Recent studies confirm the added value of the programmed intermittent bolus with nerve block catheter infusions. Automated boluses:
  • Can deliver 5 days of post-op pain relief with just a 500mL bag of local anesthetic.2, 7
  • Reduce post-op opioid consumption by 83% compared to Continuous Infusion.7
  • Enhance spread of anesthetic to make fascial plane block catheters more effective.1, 4
  • Reduce sleep disturbances by 75% compared to Continuous Infusion.7
  • Produce superior patient pain scores compared to Continuous Infusion.2, 3, 4, 7

Can Extend Post-Op Pain Relief to 5 Days
A study published in the June 2022 issue of Anesthesiology7 compared automated bolus infusions + a delay start with standard continuous infusions. According to the study authors, "a Delay Start and automated boluses decreased anesthetic consumption and prolonged [anesthetic] administration 61% to 5 days." In this same study, the authors reported a 75% reduction in sleep disturbances and better patient reported pain scores all 5 days of post-op pain relief.

Reduced Post-Op Opioid Use
A study published in the June 2022 issue of Anesthesiology7 noted reduced median cumulative opioid consumption by 83% in the automated bolus + delay start group compared to continuous infusions. A Stanford University study3 compared PIB catheter infusions to just Continuous Rate infusions for Total Knee Arthroplasty (TKA). Patients in the PIB group reported better pain scores and also used less opioids compared to the continuous infusion group.

Put Pressure and Volume Behind Your Infusion
Programmed intermittent boluses put pressure and volume behind your anesthetic infusion. Case reports and published studies cite automated boluses improve spread of local anesthetic5 and suggest that PIB boluses increase the number of affected dermatomal levels compared to Continuous Infusion6.

Superior Analgesia Via Enhanced Spread
Published studies offer evidence that larger repeated bolus doses provide superior analgesia1 — especially for fascial plane block catheters like Erector Spinae Plane (ESP) that rely on anesthetic spread in that plane. Legacy elastomeric painball pumps aren't capable of delivering automated boluses and can't generate enough pressure and volume to achieve satisfactory spread.

Extend Post Op Analgesia With Same Reservoir Size
A case report out of University of California - San Diego2 compared a PIB infusion protocol to Basal Rate infusion with infraclavicular block catheters for wrist and hand surgery. Patients in the Continuous Infusion group emptied their pump reservoirs typically after 2 days. Some patients in the PIB group had their post-op analgesia extend out to 4 days of pain relief, doubling the duration without increasing Rx reservoir size.

Another case report out of University of California - San Diego4 compared a PIB infusion protocol to Basal Rate infusion with popliteal / sciatic block catheters for ankle surgery. Pain scores for the intermittent bolus group were similar to or lower than pain scores for the continuous rate group. And, similar to the infraclavicular block catheter with PIB case report, patients in the PIB group had their infusion reservoir last until Post-Op Day 4 while the continuous group's reservoirs emptied by Day 2 or 3.

1. Finneran IV J, Alexander B, Bechis S. Continuous erector spinae plane blocks with automated boluses for analgesia following percutaneous nephrolithotomy. Korean J Anesthesiol. 2021;74(2):178-180.
2. Baskin P, Hentzen E, Swisher M. Automated intermittent boluses vs. basal infusion for infraclavicular brachial plexus catheters—a case-control series. Presented at: Annual Regional Anesthesiology and Acute Pain Medicine Meeting; May 13-15, 2021; Lake Buena Vista, FL. ePoster 1635
3. Horn A, Ban Tsui B, Amanatullah D. Recovery outcomes of total knee arthroplasty after receiving adductor canal block with intermittent bolus vs. continuous infusion. Presented at: Annual Regional Anesthesiology and Acute Pain Medicine Meeting; May 13-15, 2021; Lake Buena Vista, FL. ePoster 1617. https://epostersonline.com/ASRASPRING21/node/496?view=true.
4. Baskin P, Alexander B, Kent W. Automated intermittent boluses vs. Basal infusion for popliteal sciatic nerve catheters—a case-control series. Presented at: Annual Regional Anesthesiology and Acute Pain Medicine Meeting; May 13-15, 2021; Lake Buena Vista, FL. ePoster 1912.
5. Ilfeld BM, Gabriel RA. Basal infusion versus intermittent boluses for perineural catheters: should we take the ‘continuous’ out of ‘continuous peripheral nerve blocks’? Reg Anesth Pain Med 2019; 44: 285-6.
6. Hida K, Murata H, Ichinomiya T, Inoue H, Sato S, Hara T. Effects of programmed intermittent thoracic paravertebral bolus of levobupivacaine on the spread of sensory block: a randomized, controlled, double-blind study. Reg Anesth Pain Med 2019; 44: 326-32.
7. Finneran JJ, Said ET, Curran BP, et al. Basal infusion versus automated boluses and a delayed start timer for “continuous” sciatic nerve blocks after ambulatory foot and ankle surgery: a randomized clinical trial. Anesthesiology. 2022;136(6):970-982.

Better Pain Scores Compared to Continuous Infusion

PROGRAMMED INTERMITTENT BOLUS