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Continuous peripheral nerve blocks: state of the art
Paolo Grossi1, Massimo Allegri
1Loco-regional Anesthesia and Pain Therapy Service, Policlinico San Donato Milanese (MI) Hospital, Italy.
Current Opinion in Anaesthesiology
|March 15, 2006
Summary
Continuous peripheral nerve blocks offer effective and safe postoperative pain relief, even at home. Advancements in ultrasound guidance and catheter technology improve nerve localization and reduce local anesthetic dosage, minimizing complications.
Area of Science:
- Anesthesiology
- Pain Management
- Regional Anesthesia
Background:
- Continuous peripheral nerve blocks are increasingly utilized for postoperative analgesia.
- Optimizing technique and drug selection is crucial for patient outcomes.
Purpose of the Study:
- To review technical procedures, indications, drugs, infusion regimens, and complications of continuous peripheral nerve blocks.
- Evaluate literature published between January 2004 and April 2005.
Main Methods:
- Medline research to identify relevant articles.
- Systematic review of 27 selected studies.
Main Results:
- Stimulating catheters and ultrasound guidance enhance catheter placement accuracy, reducing local anesthetic volume.
- Levobupivacaine and ropivacaine demonstrate equianalgesia and equipotency.
- A combination of basal infusion and bolus doses is the optimal regimen for postoperative analgesia.
- Complications like infection, toxicity, hematoma, and nerve injury are rare.
Conclusions:
- Continuous peripheral nerve blockade is a safe and effective method for postoperative pain management, suitable for home administration.
- Further research is needed to refine nerve localization techniques and identify optimal, less toxic drug regimens.