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 PCA 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:
  • Enhance spread of anesthetic.1, 4
  • Make fascial plane block catheters more effective.1
  • Produce superior pain scores compared to Continuous Infusion.2, 3, 4
  • Doubled duration of analgesia with same reservoir size compared to Continuous Infusion.2

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.

Reduced Post-Op Opioid Use
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.

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.

Better Pain Scores Compared to Continuous Infusion

PROGRAMMED INTERMITTENT BOLUS