Perineural Catheters for Analgesia Following Ambulatory Surgery: Literature Review
Chai J. Chang, M.D., Timothy E. Morey, M.D.
Department of Anesthesiology, University of Florida, Gainesville, Florida
ABSTRACT
Background: Perineural local anesthetic infusions have been used with
greater frequency over the past two decades for postoperative analgesia.
However, such use in the ambulatory surgical setting is a relatively new
practice. This literature review summarizes data from randomized-controlled
studies detailing the use of perineural catheters for continuous analgesia
following surgery in the outpatient setting.
Method: The Medline/PubMed database was queried with the keywords
“ambulatory surgery, perineural local anesthetic infusion, continuous nerve
block, postoperative analgesia, and randomized controlled study”. All
investigations were included, excluding case reports.
Results: A total of six randomized, double-blinded, placebo-controlled
studies were cited. Endpoints detailed in these studies were: pain at rest,
pain with movement, need for additional opioid analgesic use and related
side effects, sleep disturbances, catheter related complications, and
patient satisfaction. Of these, five articles described studies involving
brachial plexus catheter placements using various techniques; the remaining
article reported the use of popliteal sciatic nerve catheter. The three
studies that compared local anesthetic infusions (0.2 % ropivacaine) to
placebo (0.9% saline), all demonstrated statistical and clinical
improvements in patients who received the local anesthetic infusions. The
remaining studies established that the addition of clonidine (1 ?g/ml) to
the local anesthetic infusion did not improve outcome, that there were no
differences in the selection of 0.125% bupivacaine compared to 0.125%
ropivacaine, and that the optimal dosing regimen is one with a continuous
infusion combined with patient-controlled bolus.
Conclusion: Although the use of perineural local anesthetic infusions in the
ambulatory surgical setting is a novel and growing technique, current
studies have shown it to be an effective method for postoperative analgesia.
In the context of evidence-based medicine, these studies suggest broadening
the use of the technique to improve care of patients undergoing moderate to
severely painful outpatient surgical procedures.
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