Continuous Peripheral Nerve Blocks

摘要: A continuous peripheral nerve block, also termed "perineural local anesthetic infusion," involves the percutaneous insertion of a catheter adjacent to nerve, followed by administration via catheter, providing anesthesia/analgesia for multiple days or even months. Continuous blocks may be provided in hospital setting, but use lightweight, portable pumps permits ambulatory infusion as well. This technique's most common application is analgesia after surgical procedures. However, additional indications include treating intractable hiccups; inducing sympathectomy and vasodilation increase blood flow vascular accident, digit transfer/replantation, limb salvage; alleviating vasospasm Raynaud disease; embolism chronic pain such complex regional syndrome, phantom pain, trigeminal neuralgia, cancer-induced pain. After trauma, perineural can provide during transportation distant treatment center, while simply awaiting repair. Catheter accomplished using many possible modalities, including stimulation, ultrasound guidance, paresthesia induction, fluoroscopic imaging, simple tactile perceptions ("facial click"). Either nonstimulating epidural-type used, "stimulating catheter" that delivers electrical current its tip. Administered infusate generally includes exclusively long-acting, dilute, delivered bolus only, basal basal-bolus combination. Documented benefits appear dependent on successfully improving analgesia, decreasing baseline/breakthrough/dynamic supplemental analgesic requirements, opioid-related side effects, sleep disturbances. In some cases, patient satisfaction ambulation/functioning improved; an accelerated resumption passive joint range-of-motion realized; time until discharge readiness well actual from rehabilitation center achieved. Lastly, postoperative inflammation inflammatory markers decreased. Nearly all occur itself, several randomized controlled trials suggest situations there are prolonged removal Easily rectified minor complications somewhat frequently, major risks clinically relevant infection injury relatively rare. article evidence-based review published literature involving blocks.