持续的外围神经阻塞用于疼痛的门诊手术后的止痛:一篇专注于输液技术近期发展的评论
John J Finneran1,2, Brian M Ilfeld1,2
1Department of Anesthesiology, University of California San Diego, San Diego, California.
Current opinion in anaesthesiology
|August 8, 2023
概括
持续的外周神经阻塞 (cPNB) 减少门诊手术后的疼痛和阿片类药物使用. 输液技术的进步可能会延长疼痛缓解的持续时间,改善患者的治疗结果.
科学领域:
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
- 手术创新 在外科创新.
背景情况:
- 连续的外周神经阻塞 (cPNB) 是门诊外科手术中术后疼痛管理的组成部分.
- 它们有效降低疼痛评分,阿片类药物消耗,并提高患者满意度.
研究的目的:
- 审查门诊cPNBs的演变情况.
- 探索长时间止痛的输液技术的进步.
- 讨论最佳的cPNB选择和替代的止痛方式.
主要方法:
- 文献综述侧重于cPNBs的历史,技术和临床应用.
- 对影响门诊cPNBs持续时间的因素的分析.
- 对新型止痛策略的评估.
主要成果:
- 局部麻醉剂储大小是门诊cPNB持续时间的主要限制.
- 自动螺栓和输液启动延迟计时器可能会延长止痛.
- 长效局部麻醉剂,如罗皮瓦卡因,可以延长阻塞的持续时间.
结论:
- cPNBs显著改善术后疼痛控制,并减少在门诊手术中的阿片类药物需求.
- 技术进步,特别是电子,有望扩大cPNBs的优势.
相关概念视频
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
457
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
457
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
1.1K
Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
1.1K
Local Anesthetics: Clinical Application as Spinal Anesthesia
677
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
677
Local Anesthetics: Clinical Application as Epidural Anesthesia
458
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
458
Peripheral Artery Disease V: Postoperative Nursing Management
12
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
12
Analgesia and Pain Management
657
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
657


