Continuous peripheral nerve blocks in clinical practice
Continuous peripheral nerve blocks in clinical practice
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DOI：
10.1097/aco.0b013e32830c66c2
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发表时间：
2008-10-01
影响因子：
2.5
通讯作者：
Choquet, Olivier
中科院分区：
文献类型：
--
作者：
Capdevila, Xavier;Ponrouch, Matthieu;Choquet, Olivier
本综述强调了对连续周围神经阻滞手术的适应症和指导的新见解。最近的研究发现，连续的周围神经阻滞比传统的全身性阿片类药物镇痛效果更好。文献表明，连续的周围神经阻滞延长了门诊特定部位的局麻输送时间，实现了最佳的镇痛效果，副作用最小，并避免了镇痛阻滞的过早消退。此外，已证明患者健康相关生活质量或结果效益的改善。对于术后即刻疼痛，持续的周围神经阻滞通常优于关节内局麻输注，但新的数据表明，除了多模式镇痛方案外，关节周围和关节内应用局麻可以改善术后早期镇痛和活动。最后，似乎只有对于斜角肌间神经阻滞和腘窝坐骨神经阻滞，使用刺激导管会略微降低术后疼痛和静脉阿片类药物救援镇痛的视觉模拟评分。超声引导为确定导管尖端位置提供了潜在的优势。持续的周围神经阻滞在住院或门诊病人围手术期麻醉管理中是必不可少的。超声引导和刺激导管可以在手术过程中帮助麻醉师。
Purpose of reviewThe present review highlights new insights into indications and guidance during procedures for continuous peripheral nerve blocks.Recent findingsContinuous peripheral nerve blocks consistently provide better analgesia than traditional systemic opioid-based analgesia. The literature shows that continuous peripheral nerve blocks prolong site-specific local anesthetic delivery in the outpatient setting, allow optimal analgesia, have minimal side effects, and avoid premature regression of an analgesic block. Furthermore, an improvement in patients' health-related quality of life or outcome benefits has been demonstrated. It appears that continuous peripheral nerve blocks are generally superior to intraarticular local anesthetic infusion for immediate postoperative pain, but new data demonstrate that, apart from a multimodal analgesia regimen, periarticular and intraarticular application of local anesthetics can improve early postoperative analgesia and mobilization. Finally, it seems that, only for interscalene and popliteal sciatic nerve blocks, the use of stimulating catheters slightly decreases visual analog scale scores for postoperative pain and intravenous opioid rescue analgesia. Ultrasound guidance offers the potential advantage to confirm catheter tip location.SummaryContinuous peripheral nerve blocks are essential in the perioperative anesthetic management of in-hospital or ambulatory patients. Ultrasound guidance and stimulating catheters can help anesthetists during the procedure.