title: Regional anesthesia in pain management.
abstract: OBJECTIVE
  The study focuses on neural blocks with local anesthetics in postoperative and chronic pain. It is prompted by the recent publication of several systematic reviews and guidelines.
  
  
  RESULTS
  For postoperative pain, the current evidence supports infusions of local anesthetics at the surgical site, continuous peripheral nerve blocks, and neuraxial analgesia for major thoracic and abdominal procedures. Ultrasound guidance can improve the performance of the blocks and different patient outcomes, although the incidence of peripheral nerve damage is not decreased. For chronic pain, the best available evidence is on nerve blocks for the diagnosis of facet joint pain. Further research is needed to validate diagnostic nerve blocks for other indications. Therapeutic blocks with only local anesthetics (greater occipital nerve and sphenopalatine ganglion) are effective in headache. A possible mechanism is modulation of central nociceptive pathways. Therapeutic nerve blocks for other indications are mostly supported by retrospective studies and case series.
  
  
  CONCLUSIONS
  Recent literature strongly supports the use of regional anesthesia for postoperative pain, whereby infusions at peripheral nerves and surgical site are gaining increasing importance. Local anesthetic blocks are valid for the diagnosis of facet joint pain and effective in treating headache. There is a need for further research in diagnostic and therapeutic blocks for chronic pain.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Curatolo
mesh_terms: D000779:Anesthetics, Local; D059350:Chronic Pain / Q000628:therapy*; D006801:Humans; D009407:Nerve Block / Q000379:methods* / Q000592:standards; D009434:Neural Pathways / Q000187:drug effects; D059408:Pain Management / Q000379:methods* / Q000592:standards; D010149:Postoperative Pain / Q000628:therapy*; D017410:Practice Guidelines as Topic; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local