PIEB (Programmed Intermittent Epidural Bolus) anaesthesia is an epidural anaesthesia technique that is becoming increasingly relevant in hospital delivery rooms throughout the world, as well as in operating rooms where this type of anaesthesia is used.

What is epidural anaesthesia?

Epidural anaesthesia involves the infusion of a local anaesthetic agent into the epidural space of the patient’s spine by means of a puncture and, if necessary, the introduction of a catheter. It acts by supressing the pain in the nerves that are reached by the anaesthetic. Since the spinal cord is the origin of the nerve roots that innervate the entire body, the effects of the anaesthesia in different areas of the body will depend on the height at which it is applied.

The most common area of application for epidural anaesthesia is the lumbar area, which minimises the pain of child labour and the mother’s anxiety, in addition to allowing for other kinds of surgical procedures in the lower limbs, genitals and pelvis.

It is a widely-used procedure in childbirth, unless when contraindicated for a specific reason.

Although its first trials date back to the end of the 19th century, the Spanish military doctor Fidel Pagés is considered to be the inventor of this technique, which he began developing in 1922. However, it was not until 1942 that people began using continuous epidural infusion procedures in childbirth, and decades passed until its use became widespread.

What is PIEB anesthesia?

As its name suggests, PIEB is an epidural anaesthesia procedure in which the administration of anaesthetic drugs is done intermittently through the administration of boluses at pre-programmed intervals, with the patient also having the ability to demand additional boluses if they feel pain.

Epidural anaesthesia using PIEB requires the use of an infusion pump that is prepared for this type of procedure (such as the arcomed Chroma pumps), which must also incorporate a push button for the patient to demand boluses.  

How is PIEB anaesthesia performed?

Once the catheter is inserted, a bolus is usually administered manually, which serves as a loading dose for establishing the epidural anaesthesia. Afterwards, the pump will administer the desired volume of boluses at the programmed intervals. After the administration of each bolus, there is a blocked time in which boluses are not administered at the patient’s demand, although they can be administered if determined necessary by the clinical team. Once the blocked time has ended, the pump will allow for the administration of patient boluses, always taking into account the dosage limits that have been set for each drug.

PIEB anaesthesia vs traditional epidural anaesthesia

Numerous clinical studies have shown that PIEB anaesthesia offers many more advantages, both for the patient and for the hospital, when compared to classic epidural anaesthesia. Its main advantages are the following:

  • Reduction in the use of anaesthetic drugs
  • Fewer manual bolus requests
  • Greater patient comfort and well-being
  • Reduced recovery time
  • Significant reduction in side effects, especially at the motor level.

All of this results in a better experience for the patient, while also saving costs, both in medication and in time (resuscitation, prolongation of hospitalisation due to possible side effects, etc.) while ensuring maximum safety.