Approaching trauma analgesia using prolonged and novel continuous peripheral nerve blocks - A case report (original) (raw)
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Open Journal of Anesthesiology, 2012
Bilateral brachial plexus blocks and regional anesthesia in trauma patients are rarely performed due to potential complications when using these techniques. We illustrate a case in which bilateral infraclavicular nerve blocks were placed as part of a multimodal approach to pain management in a trauma patient. We discuss potential hazards, important considerations, and rationale for attempting this procedure. Ultimately, performing bilateral brachial plexus nerve blocks in trauma patients is a viable option when choosing pain management techniques.
Peripheral Nerve Blocks in Non-Operative Settings: A Review of the Evidence and Technical Commentary
Journal of Anesthesia & Clinical Research, 2014
This narrative review summarizes and comments the evidence derived from randomized controlled trials pertaining to the efficacy of peripheral nerve blocks in non-operative settings. The literature search was conducted using the Medline (1966-present), Embase (1980-present), Web of Science (1900-present) and Sciverse Scopus (1996-present) databases. The following search terms were used: ("peripheral nerve block" OR "brachial plexus block" OR "interscalene block" OR "supraclavicular block" OR "infraclavicular block" OR "axillary block" OR "humeral canal block" OR "lumbosacral plexus block" OR "lumbar plexus block" OR "femoral nerve block" OR "lateral femoral cutaneous block" OR "obturator nerve block" OR "sciatic nerve block") AND ("fractures" OR "Emergency Room" OR "Emergency Department" OR "ambulance" OR "prehospital" OR "Intensive Care Unit" OR "Intensive Care"). Only randomized controlled trials were retained for analysis. Despite methodological shortcomings, the available evidence suggests that peripheral nerve blocks can provide pain control for upper and lower limb trauma in non-operative settings. For instance, brachial plexus blocks offer a useful alternative to procedural sedation for fracture manipulation in the Emergency Department. Lumbar plexus, 3-in-1 and femoral blocks can provide analgesia for patients with hip fractures. Femoral blocks also result in more comfortable ambulance transfers to the hospital for patients suffering from hip and knee trauma. Finally, in very elderly subjects, fascia iliaca blocks can decrease the incidence and duration of perioperative delirium. Published reports of randomized trials provide evidence to formulate limited recommendations regarding the use of peripheral nerve blocks in non-operative settings. Further well-designed studies are warranted. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h
Upper extremity nerve block: how can benefit, duration, and safety be improved? An update
F1000Research, 2016
Upper extremity blocks are useful as both sole anaesthesia and/or a supplement to general anaesthesia and they further provide effective postoperative analgesia, reducing the need for opioid analgesics. There is without doubt a renewed interest among anaesthesiologists in the interscalene, supraclavicular, infraclavicular, and axillary plexus blocks with the increasing use of ultrasound guidance. The ultrasound-guided technique visualising the needle tip and solution injected reduces the risk of side effects, accidental intravascular injection, and possibly also trauma to surrounding tissues. The ultrasound technique has also reduced the volume needed in order to gain effective block. Still, single-shot plexus block, although it produces effective anaesthesia, has a limited duration of postoperative analgesia and a number of adjuncts have been tested in order to prolong analgesia duration. The addition of steroids, midazolam, clonidine, dexmedetomidine, and buprenorphine has been st...
Safety and Efficacy of Rescue Nerve Blocks
Journal of Clinical and Biomedical Investigation, 2022
Background: The overall incidence of complications following peripheral nerve blocks is very low. Peripheral nerve blocks performed under ultrasound guidance are widely thought to present a lower risk to direct needle trauma than paresthesia and nerve stimulation techniques and have been shown to decrease opioid consumption by providing analgesia directly to the site of injury. Currently, when a nerve block fails altogether or provides inadequate analgesia, pain and opioid consumption increases which in turn decrease patient satisfaction and increases healthcare costs. Concerns remain whether the benefits of opioid reduction outweigh the risk of inadvertent needle trauma and other potential complications when performing a nerve block replacement, or ‘rescue block’. Objective: Examine whether performing a rescue peripheral nerve block provides adequate analgesia to elicit a decrease in opioid consumption. Analyze the incidence of nerve injury following ultrasound-guided ‘rescue’ cont...
Anesthesiology, 2005
Postoperative analgesia is generally limited to 12-16 h or less after single-injection regional nerve blocks. Postoperative analgesia may be provided with a local anesthetic infusion via a perineural catheter after initial regional block resolution. This technique may now be used in the outpatient setting with the relatively recent introduction of reliable, portable infusion pumps. In this review article, we summarize the available published data related to this new analgesic technique and highlight important issues related specifically to perineural infusion provided in patients' own homes. Topics include infusion benefits and risks, indications and patient selection criteria, catheter, infusion pump, dosing regimen, and infusate selection, and issues related specifically to home-care.
Continuous peripheral nerve blockade for postoperative analgesia
Current Opinion in Anaesthesiology, 2008
Purpose of review To review the recent literature involving the use of continuous peripheral nerve sheath catheters in the management of postoperative pain. Recent findings Continuous peripheral nerve blocks provide superior analgesia and are associated with fewer opioid-induced side effects for patients undergoing extremity surgery. Ultrasound technology is being used with increasing frequency to guide the placements of continuous peripheral nerve blocks. The evidence is still equivocal regarding the superiority of stimulating versus nonstimulating catheters for the delivery of continuous peripheral nerve blockade. The incidence of major complications associated with continuous peripheral nerve blocks is very low and probably no different from single injection peripheral nerve blocks. Summary Continuous peripheral nerve blocks are an excellent additional modality to compliment other multimodal analgesics to control moderate to severe postoperative pain.
Lower extremity nerve blocks in pediatric patients
Techniques in Regional Anesthesia and Pain Management, 2003
Pediatric applications of plexus and conduction nerve blocks have increased considerably in recent years, and they have indications in virtually all aspects of surgical and procedural pain, including outpatient surgery, whether the techniques are used in conscious patients or in combination with general anesthesia. Lower extremity nerve blocks remain underutilized despite their many advantages in terms of efficacy, safety and ease with which they can be performed with the help of a nerve stimulator. A major improvement in recent years consisted in the development of techniques allowing catheter placement for continuous infusion of local anesthetics. SURGICAL PAIN COMPONENTS Postoperative pain is multifactorial and results from several conditions including: 1) skin and muscle trauma, trauma to the fascias, periosteum and bones (somatic pain); 2) ischemia of mesenteric vessels and traction of peritoneum (visceral pain); 3) local inflammatory disorders and spinal reflexes (inflammation and neural plasticity); and 4) joint mobilizations, wound dressings, venepunctures and other types of procedural pain. Postoperative pain depends both on central sensitization [5,6] and an input from the periphery (tissue trauma).[7,8] Prevention and treatment of the persistent pain should focus on targeting both central sensitization (e.g., opioids), as well as active peripheral nerve nociceptive input. The latter goal at present can be reliably achieved only by interrupting the transmission from the peripheral nerve fibers supplying the injured area. Of note, while parenteral opioids and regional blocks techniques are equally effective on postoperative pain at rest, only regional blocks can 1) suppress pain on mobilization of patients and procedural pain, and 2) prevent inflammatory disorders and neural plasticity.[9] SELECTION OF THE ANALGESIC MODALITIES FOR POST-OPERATIVE ANALGESIA Although perception of pain is highly variable among patients, it is possible to estimate the intensity and RATIONALE DALENS B