Correspondence  |   May 2006
Proper Priority Please
Author Affiliations & Notes
  • Kenichi Ueda, M.D., Ph.D.
  • *The University of Iowa Hospitals and Clinics, Iowa City, Iowa. or
Article Information
Correspondence   |   May 2006
Proper Priority Please
Anesthesiology 5 2006, Vol.104, 1105. doi:
Anesthesiology 5 2006, Vol.104, 1105. doi:
In Reply:—
We read with interest the comments from Dr. Wildsmith. We agree that many investigators have made important contributions to the mode of epidural infusion. A comparison between continuous infusion versus  bolus technique was reported in 1975.1 Drs. Scott, Schweitzer, and Thorn used a pump to administer regular intermittent top-up doses 1982.2 Doses were 6–10 ml local anesthetic every 2 h. Observations with the regimen included “the spread of nerve block was much wider than necessary.”
The fundamental difference we described is a much smaller volume of the local anesthetic and more frequent administration. Our technique delivers a mini-bolus of 1 ml local anesthetic every 20 min.3 Compared with the large-volume, intermittent top-up technique described above, our method is closer to the continuous infusion technique. Like a continuous infusion, the incidence of hypotension or bradycardia is negligible with our technique. However, the quality of analgesia is superior. An analogy is a quiet beach where small waves repeatedly wet the sand. We believe our small, frequent-dose technique is a new and effective method of epidural analgesia.
*The University of Iowa Hospitals and Clinics, Iowa City, Iowa. or
Griffiths DP, Diamond AW, Cameron JD: Postoperative extradural analgesia following thoracic surgery: A feasibility study. Br J Anaesth 1975; 47:48–55Griffiths, DP Diamond, AW Cameron, JD
Scott DB, Schweitzer S, Thorn J: Epidural block in postoperative pain relief. Reg Anesth 1982; 7:135–9Scott, DB Schweitzer, S Thorn, J
Ueda K, Ueda W, Manabe M: A comparative study of sequential epidural bolus technique and continuous epidural infusion. Anesthesiology 2005; 103:126–9Ueda, K Ueda, W Manabe, M