title: Peripheral nerve catheters and local anesthetic infiltration in perioperative analgesia.
abstract: Peripheral nerve catheters (PNCs) and local infiltration analgesia (LIA) represent valuable options for controlling perioperative pain. PNCs have been increasingly utilized to provide both surgical anesthesia and prolonged postoperative analgesia for a wide variety of procedures. PNCs can be more technically challenging to place than typical single-injection nerve blocks (SINB), and familiarity with the indications, contraindications, relevant anatomy, and appropriate technical skills is a prerequisite for the placement of any PNC. PNCs include risks of peripheral nerve injury, damage to adjacent anatomic structures, local anesthetic toxicity, intravascular injection, risks associated with motor block, risks of unnoticed injury to the insensate limb, and risks of sedation associated with PNC placement. In addition to these common risks, there are specific risks unique to each PNC insertion site. LIA strategies have emerged that seek to provide the benefit of targeted local anesthesia while minimizing collateral motor block and increasing the applicability of durable local anesthesia beyond the extremities. LIA involves the injection and/or infusion of a local anesthetic near the site of surgical incision to provide targeted analgesia. A wide variety of techniques have been described, including single-injection intraoperative wound infiltration, indwelling wound infusion catheters, and the recent high-volume LIA technique associated with joint replacement surgery. The efficacy of these techniques varies depending on specific procedures and anatomic locations. The recent incorporation of ultra-long-acting liposomal bupivacaine preparations has the potential to dramatically increase the utility of single-injection LIA. LIA represents a promising yet under-investigated method of postoperative pain control.
authors.affiliation: Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA. Electronic address: ckmerritt@gmail.com.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Merritt
authors.affiliation: Department of Anesthesiology and Perioperative Care Service, Stanford School of Medicine and the VA Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA 94304, USA. Electronic address: emariano@stanford.edu.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Mariano
authors.affiliation: Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA. Electronic address: alankaye44@hotmail.com.
authors.forename: Alan David
authors.initials: AD
authors.lastname: Kaye
authors.affiliation: Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA. Electronic address: jonlissauer@gmail.com.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lissauer
authors.affiliation: Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA. Electronic address: kmancu@lsuhsc.edu.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mancuso
authors.affiliation: Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA. Electronic address: amitprabhakar7@gmail.com.
authors.forename: Amit
authors.initials: A
authors.lastname: Prabhakar
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, USA. Electronic address: rurman@partners.org.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
mesh_terms: D000698:Analgesia / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage; D002404:Catheterization; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D019990:Perioperative Care / Q000379:methods; D010525:Peripheral Nerves
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine
keywords: local infiltration analgesia; peripheral nerve catheter; regional anesthesia; ultrasound-guided blocks