Programmed Intermittent Bolus versus Continuous Infusion for Regional Analgesia Following Thoracoscopic Surgery: A Systematic Review and Meta-Analysis.

Background: Continuous regional analgesia techniques have emerged as a more effective alternative for postoperative analgesia, but the clinical efficacy of infusion modes in thoracoscopic surgery remains controversial. This systematic review and meta-analysis to compare the efficacy of programmed intermittent bolus infusion (PIBI) with continuous infusion (CI) for regional analgesia in patients undergoing thoracoscopic surgery.

Methods: We searched PubMed, Embase, Web of Science, and the Cochrane Library for relevant research from inception to March 2025. Randomized controlled trials (RCTs) comparing PIBI with CI for regional analgesia following thoracoscopic surgery were included. The meta-analysis was made by using ReMan 5.4 software.

Results: We included 7 RCTs with 394 patients. For resting VAS at 6 h, there was no significant difference between PIBI and CI (MD = -0.52, 95% CI: -1.23 to 0.20). PIBI was more likely to reduce the resting VAS at 12 h, movement VAS at 12 h, and morphine consumption in first 24 h. PIBI had lower local anesthetic consumption and wider range of sensory blockade than CI. However, there were no significant difference between PIBI and CI in terms of the resting VAS at 24 h, resting VAS at 48 h, movement VAS at 6 h, movement VAS at 24 h, movement VAS at 48 h, morphine consumption in second 24 h, and number of people using additional analgesics.

Conclusion: PIBI provided a lower local anesthetic consumption and a wider sensory blockade compared to CI for regional analgesia following thoracoscopic surgery, although no significant clinical differences were observed in postoperative pain scores, opioid consumptions, and number of people using additional analgesics.

Limitation: The heterogeneity may influence the pooled estimates, the conclusion was only suitable for pulmonary surgery, the lack of long-term follow-up data on chronic pain outcomes.