TY - JOUR
T1 - An in vitro evaluation of the pressure generated during programmed intermittent epidural bolus injection at varying infusion delivery speeds
AU - Klumpner, Thomas T.
AU - Lange, Elizabeth M.S.
AU - Ahmed, Heena S.
AU - Fitzgerald, Paul C.
AU - Wong, Cynthia A.
AU - Toledo, Paloma
N1 - Funding Information:
Financial support: Paloma Toledo, MD, MPH, was supported by a grant from the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development program (award 69779 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Robert Wood Johnson Foundation.
Publisher Copyright:
© 2016 Elsevier Inc.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Study objective Programmed intermittent bolus injection of epidural anesthetic solution results in decreased anesthetic consumption and better patient satisfaction compared with continuous infusion, presumably by better spread of the anesthetic solution in the epidural space. It is not known whether the delivery speed of the bolus injection influences analgesia outcomes. The objective of this in vitro study was to determine the pressure generated by a programmed intermittent bolus pump at 4 infusion delivery speeds through open-ended, single-orifice and closed-end, multiorifice epidural catheters. Design In vitro observational study. Setting Not applicable. Patients Not applicable. Interventions A CADD-Solis Pain Management System v3.0 with Programmed Intermittent Bolus Model 2110 was connected via a 3-way adapter to an epidural catheter and a digital pressure transducer. Pressures generated by delivery speeds of 100, 175, 300, and 400 mL/h of saline solution were tested with 4 epidural catheters (2 single orifice and 2 multiorifice). These runs were replicated on 5 pumps. Analysis of variance was used to compare the mean peak pressures of each delivery speed within each catheter group (single orifice and multiorifice). Main results Thirty runs at each delivery speed were performed with each type of catheter for a total of 240 experimental runs. Peak pressure increased with increasing delivery speeds in both catheter groups (P < .001). Peak pressures were higher with the multiorifice catheter compared with the single-orifice catheter at all delivery speeds (P < .001, for all). Conclusion Using a pump designed for programmed intermittent infusion boluses, the delivery speed of saline solution through epidural catheters was directly related to the peak pressures. Future work should evaluate whether differences in the delivery speed of anesthetic solution into the epidural space correlate with differences in the duration and quality of analgesia during programmed intermittent epidural bolus delivery.
AB - Study objective Programmed intermittent bolus injection of epidural anesthetic solution results in decreased anesthetic consumption and better patient satisfaction compared with continuous infusion, presumably by better spread of the anesthetic solution in the epidural space. It is not known whether the delivery speed of the bolus injection influences analgesia outcomes. The objective of this in vitro study was to determine the pressure generated by a programmed intermittent bolus pump at 4 infusion delivery speeds through open-ended, single-orifice and closed-end, multiorifice epidural catheters. Design In vitro observational study. Setting Not applicable. Patients Not applicable. Interventions A CADD-Solis Pain Management System v3.0 with Programmed Intermittent Bolus Model 2110 was connected via a 3-way adapter to an epidural catheter and a digital pressure transducer. Pressures generated by delivery speeds of 100, 175, 300, and 400 mL/h of saline solution were tested with 4 epidural catheters (2 single orifice and 2 multiorifice). These runs were replicated on 5 pumps. Analysis of variance was used to compare the mean peak pressures of each delivery speed within each catheter group (single orifice and multiorifice). Main results Thirty runs at each delivery speed were performed with each type of catheter for a total of 240 experimental runs. Peak pressure increased with increasing delivery speeds in both catheter groups (P < .001). Peak pressures were higher with the multiorifice catheter compared with the single-orifice catheter at all delivery speeds (P < .001, for all). Conclusion Using a pump designed for programmed intermittent infusion boluses, the delivery speed of saline solution through epidural catheters was directly related to the peak pressures. Future work should evaluate whether differences in the delivery speed of anesthetic solution into the epidural space correlate with differences in the duration and quality of analgesia during programmed intermittent epidural bolus delivery.
KW - Epidural infusion pumps
KW - Pressure
KW - Programmed intermittent epidural bolus
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U2 - 10.1016/j.jclinane.2016.06.017
DO - 10.1016/j.jclinane.2016.06.017
M3 - Article
C2 - 27687462
AN - SCOPUS:84980022850
VL - 34
SP - 632
EP - 637
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
SN - 0952-8180
ER -