Continuous Peripheral Nerve Block: A Novel Technique (original) (raw)
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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.
Novel Regional Nerve Blocks in Clinical Practice: Evolving Techniques for Pain Management
Anesthesiology and Pain Medicine, 2021
This review examines the use of novel US-guided nerve blocks in clinical practice. Erector spinae block is a regional anesthesia technique doing by injecting a local anesthetic among the erector spinae muscle group and transverse processes. The phrenic nerve is a branch of the cervical plexus, arising from the anterior rami of cervical nerves C3, C4, and C5. The quadratus lumborum muscle is located along the posterior abdominal wall. It originates from the transverse process of the L5 vertebral body, the iliolumbar ligament, and the iliac crest. US-guided peripheral nerve procedures have a considerable scope of use, including treating headaches and hiccups to abdominal surgical pain, cesarean sections, musculoskeletal pathologies. These nerve blocks have been an effective addition to clinical anesthesia practice. The use of peripheral nerve blocks has improved postoperative pain, lessened the use of opioids and their potential side effects, and decreased the incidence of sleep disturbance in patients. More research should be done to further delineate the potential benefits of these blocks.
PLOS ONE, 2015
Background The use of peripheral nerve blocks for anesthesia and postoperative analgesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Numerous randomized controlled trials and meta-analyses have examined the pros and cons of the use of various individual adjuvants. Objectives To systematically review adjuvant-related randomized controlled trials and meta-analyses and provide clinical recommendations for the use of adjuvants in peripheral nerve blocks. Methods Randomized controlled trials and meta-analyses that were published between 1990 and 2014 were included in the initial bibliographic search, which was conducted using Medline/ PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Only studies that were published in English and listed block analgesic duration as an outcome were included. Trials that had already been published in the identified meta-analyses and included adjuvants not in widespread use and published without an Investigational New Drug application or equivalent status were excluded. Results Sixty one novel clinical trials and meta-analyses were identified and included in this review. The clinical trials reported analgesic duration data for the following adjuvants: buprenorphine (6), morphine (6), fentanyl (10), epinephrine (3), clonidine (7), dexmedetomidine (7), dexamethasone (7), tramadol (8), and magnesium (4). Studies of perineural buprenorphine, clonidine, dexamethasone, dexmedetomidine, and magnesium most consistently demonstrated prolongation of peripheral nerve blocks.
Anesthesia and Pain Medicine, 2021
Background A supraclavicular brachial plexus nerve block provides analgesia for the shoulder, arm, and hand; however, the maximum safe duration for a continuous infusion remains controversial. A novel continuous peripheral nerve block (CPNB) technique combining the Lateral, Intermediate, and Medial femoral cutaneous nerves (termed the ‘LIM’ block) to provide analgesia to the lateral, anterior, and medial cutaneous areas of the thigh while preserving quadriceps strength will also be described in detail here. CaseWe present a complex case in which simultaneous utilization of an unilateral supraclavicular CPNB (5 weeks) and bilateral LIM CPNB (5 days) are successfully performed to provide analgesia for a traumatic degloving injury resulting in multiple surgeries.Conclusions The analgesic plan in this case study eliminated previous episodes of opioid-induced delirium, facilitated participation in recovery, and removed concerns for respiratory depression and chronic opioid use in a patie...
Anesthesia & Analgesia, 2009
BACKGROUND: It remains unclear whether local anesthetic concentration or total drug dose is the primary determinant of continuous peripheral nerve block effects. The only previous investigation, involving continuous popliteal-sciatic nerve blocks, specifically addressing this issue reported that insensate limbs were far more common with higher volumes of relatively dilute ropivacaine compared with lower volumes of relatively concentrated ropivacaine. However, it remains unknown if this relationship is specific to the sciatic nerve in the popliteal fossa or whether it varies depending on anatomic location. We therefore tested the null hypothesis that providing ropivacaine at different concentrations and rates, but at an equal total basal dose, produces comparable effects when used in a continuous infraclavicular brachial plexus block. METHODS: Preoperatively, an infraclavicular catheter was inserted using the coracoid approach in patients undergoing moderately painful orthopedic surgery distal to the elbow. Patients were randomly assigned to receive a postoperative perineural ropivacaine infusion of either 0.2% (basal 8 mL/h, bolus 4 mL) or 0.4% (basal 4 mL/h, bolus 2 mL) through the second postoperative day. Both groups, therefore, received 16 mg of ropivacaine each hour with a possible addition of 8 mg every 30 min via a patient-controlled bolus dose. Our primary end point was the incidence of an insensate limb during the 24-h period beginning the morning after surgery. Secondary end points included analgesia and patient satisfaction. RESULTS: Patients given 0.4% ropivacaine (n ϭ 27) experienced an insensate limb, a mean (sd) of 1.8 (1.6) times, compared with 0.6 (0.9) times for subjects receiving 0.2% ropivacaine (n ϭ 23; estimated difference ϭ 1.2 episodes, 95% confidence interval, 0.5-1.9 episodes; P ϭ 0.001). Satisfaction with postoperative analgesia (scale 0-10, 10 ϭ highest) was scored a median (25th-75th percentiles) of 10.0 (8.0-10.0) in Group 0.2% and 7.0 (5.3-8.9) in Group 0.4% (P ϭ 0.018). Analgesia was similar in each group. CONCLUSIONS: For continuous infraclavicular nerve blocks, local anesthetic concentration and volume influence perineural infusion effects in addition to the total mass of local anesthetic administered. Insensate limbs were far more common with smaller volumes of relatively concentrated ropivacaine. This is the opposite of the relationship previously reported for continuous popliteal-sciatic nerve blocks. The interaction between local anesthetic concentration and volume is thus complex and varies among catheter locations.
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.
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