From labor to surgery: expanding the role of programmed intermittent epidural bolus beyond obstetric

Epidural analgesia has been effective for postoperative pain control, but its use has declined owing to adverse effects, such as motor blockade and delayed recovery. However, in obstetric anesthesia, it remains the gold standard of care, especially with the development of programmed intermittent epidural bolus (PIEB), which delivers boluses of local anesthetic at fixed intervals to improve drug spread and reduce motor blockade. Clinical studies on labor analgesia have demonstrated that PIEB offers superior analgesia, lower anesthetic consumption, and higher maternal satisfaction than continuous epidural infusion. These advantages align well with Enhanced Recovery after Surgery protocols, supporting early mobilization and opioid-sparing strategies. While most evidence comes from obstetric settings, emerging data suggest that PIEB also benefits perioperative patients and holds promise for broader surgical applicability. This review explores current knowledge and emerging evidence regarding the potential application of PIEB beyond labor analgesia.