title: American Society of Regional Anesthesia and Pain Medicine 2010 Gaston Labat Lecture: Perineural catheter analgesia as a routine method after ambulatory surgery--effective but unrealistic.
abstract: Adequate postoperative analgesia is a prerequisite for successful ambulatory surgery and remains a challenge. The problem of pain at home may be increasing because previously inpatient surgical procedures are becoming ambulatory and it is expected that the number and complexity of ambulatory surgical procedures will continue to increase. In 1998, we described the use of surgical-site and perineural catheter techniques that allowed patients to self-administer local anesthetics through disposable, elastomeric pumps for pain management at home. In recent years, availability of improved elastometric and other lightweight pump devices, the general trend of avoiding strong opioids and the preference for non-opioid analgesic techniques has led to increasing use of this technique after a variety of ambulatory surgical procedures. The two most common techniques are perineural and wound catheter infusions (WCI). Current evidence suggests that both are effective, although comparative studies are lacking. Perineural techniques are highly effective but are technically challenging and require labor-intensive and expensive home care that can be provided only in specialized centers. Disappointing past experience with implementation of perineural catheter techniques in inpatients suggests that it is unrealistic to expect their routine use in most ambulatory centers. Surgical-site catheter technique is a simpler, safer, and less expensive alternative and therefore more likely to gain widespread use. Only controlled comparisons can show whether the current belief about the superiority of ambulatory perineural techniques over WCI is justified. Such studies should address technical failures, side effects, home care of the medically unsupervised or undersupervised patient, and cost-effectiveness to demonstrate which of the 2 techniques is most appropriate for a particular procedure.
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden. n.rawal@orebroll.se
authors.forename: Narinder
authors.initials: N
authors.lastname: Rawal
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002404:Catheterization / Q000009:adverse effects; D006801:Humans; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D012646:Self Administration; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local