The type and necessity
of the bolus feature may
be dependent on the pro-
cedure, says Dr.
Winchester, who adds
that interscalenes and
femorals don't seem to
need a bolus because
"the nerve is so easily
covered by the catheter
trickle infusion."
While this would allow
the simplest of all set-
tings — "Just set the
pump at a certain rate,
leave it running, and
don't let it go up or
down," says Dr.
Winchester — the poten-
tial downside is that if
the local isn't spreading
well enough, you don't have the ability to turn it up, he says. And if
you leave it at a higher rate, the anesthetic could spread to the
phrenic nerve, which causes shortness of breath, he adds.
Some other blocks, on the other hand, strongly indicate the need for
a pre-scheduled bolus, delivered at specific intervals, says Dr.
Winchester. That feature is available only with electronic pumps. One
such block is the fascia iliaca, because the tip of catheter isn't close
enough to the nerves; another is the TAP (transversus abdominis
plane), because volume spread delivered by a bolus may be needed to
F E B R U A R U Y 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 1 1 5
BREAKTHROUGH KNOWLEDGE Pain pumps with a bolus option for patients
can help providers gauge how well pain pumps are working, says anesthesiolo-
gist Steven Butz, MD, of the Children's Hospital of Wisconsin Surgicenter in
Milwaukee.
Laura
Luebtke
