Peripheral nerve blocks for anaesthesia and postoperative analgesia.
OBJECTIVE
Perioperative analgesia is a major concern for the patient and for the anesthesiologist, whose task is to avoid pain and all related complications on immediate outcome and healing. Regional anesthesia, alone or combined with general anesthesia, is becoming a preferred technique in a variety of surgical procedures. There is increasing interest in peripheral nerve blocks, single or continuous, mainly for perioperative treatment of unilateral surgery. Specificity of analgesic area combined with decreased complications, including spinal or epidural hematoma, urinary retention, or hemodynamic alterations, are advantages of the peripheral nerve block over more central neural blocks.


RESULTS
Insertion of catheters near neural plexuses or in the vicinity of single nerves are being continuously developed and improved. The appearance of new techniques and devices is increasing. Percutaneous electrode guidance, ultrasonographic localization of neural structures, and the use of stimulating catheters represent the newest advances in this area. Use of enantiomeric local anesthetic drugs permits a safer and wider range of postoperative treatment, which includes continuous analgesia administered in the patient's home. Use of patient-controlled analgesia, through electronic or elastomeric pumps, is recommended for postoperative pain control. Peripheral nerve block is the standard for anesthesia or analgesia in ambulatory surgery. Complications of the technique have been examined in large clinical studies which have recently been published. Results of such studies highlight the effectiveness and safety of peripheral blocks. These results have given new strength to arguments for regional anesthesia and analgesia and led to the increase in popularity of regional techniques. The articles considered below have, in summary, the main purpose of enhancing safety, as well as dissemination and education regarding regional anesthetic techniques.


CONCLUSIONS
Possibilities afforded by the use of peripheral nerve blocks mainly consist of prolonged analgesia, selective area of action, and fewer collateral effects when compared with general anesthesia or more central neural blockade. Introduction of new devices and new techniques are increasing, as evidenced by the large number of studies which have appeared in the literature during the past year.
Grossi
Paolo
P
Regional Anesthesia and Pain Treatment, Istituto Policlinico San Donato, Milan, Italy. paolo.grossi@grupposandonato.it
Urmey
William F
WF