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Edward R Mariano - One of the best experts on this subject based on the ideXlab platform.
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Peripheral Nerve Block anesthesia analgesia for patients undergoing primary hip and knee arthroplasty recommendations from the international consensus on anesthesia related outcomes after surgery icaros group based on a systematic review and meta analysis of current literature
Regional Anesthesia and Pain Medicine, 2021Co-Authors: Stavros G Memtsoudis, Crispiana Cozowicz, Janis Bekeris, Dace Bekere, Jiabin Liu, Ellen M Soffin, Edward R MarianoAbstract:Background Evidence-based international expert consensus regarding the impact of Peripheral Nerve Block (PNB) use in total hip/knee arthroplasty surgery. Methods A systematic review and meta-analysis: randomized controlled and observational studies investigating the impact of PNB utilization on major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, thromboembolic, neurologic, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, were queried from 1946 to August 4, 2020. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess evidence quality and for the development of recommendations. Results Analysis of 122 studies revealed that PNB use (compared with no use) was associated with lower ORs for (OR with 95% CIs) for numerous complications (total hip and knee arthroplasties (THA/TKA), respectively): cognitive dysfunction (OR 0.30, 95% CI 0.17 to 0.53/OR 0.52, 95% CI 0.34 to 0.80), respiratory failure (OR 0.36, 95% CI 0.17 to 0.74/OR 0.37, 95% CI 0.18 to 0.75), cardiac complications (OR 0.84, 95% CI 0.76 to 0.93/OR 0.83, 95% CI 0.79 to 0.86), surgical site infections (OR 0.55 95% CI 0.47 to 0.64/OR 0.86 95% CI 0.80 to 0.91), thromboembolism (OR 0.74, 95% CI 0.58 to 0.96/OR 0.90, 95% CI 0.84 to 0.96) and blood transfusion (OR 0.84, 95% CI 0.83 to 0.86/OR 0.91, 95% CI 0.90 to 0.92). Conclusions Based on the current body of evidence, the consensus group recommends PNB use in THA/TKA for improved outcomes. Recommendation: PNB use is recommended for patients undergoing THA and TKA except when contraindications preclude their use. Furthermore, the alignment of provider skills and practice location resources needs to be ensured. Evidence level: moderate; recommendation: strong.
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immediate effects of a continuous Peripheral Nerve Block on postamputation phantom and residual limb pain secondary outcomes from a multicenter randomized controlled clinical trial
Anesthesia & Analgesia, 2021Co-Authors: Brian M Ilfeld, Edward R Mariano, Bahareh Khatibi, Kamal Maheshwari, Sarah J Madison, Wael Ali Sakr Esa, Michael L KentAbstract:BACKGROUND We recently reported that a 6-day continuous Peripheral Nerve Block reduced established postamputation phantom pain 3 weeks after treatment ended. However, the immediate effects of perineural infusion (secondary outcomes) have yet to be reported. METHODS Participants from 5 enrolling academic centers with an upper or lower limb amputation and established phantom pain received a single-injection ropivacaine Peripheral Nerve Block(s) and perineural catheter insertion(s). They were subsequently randomized to receive a 6-day ambulatory perineural infusion of either ropivacaine 0.5% or normal saline in a double-masked fashion. Participants were contacted by telephone 1, 7, 14, 21, and 28 days after the infusion started, with pain measured using the Numeric Rating Scale. Treatment effects were assessed using the Wilcoxon rank-sum test at each time point. Adjusting for 4 time points (days 1, 7, 14, and 21), P < .0125 was deemed statistically significant. Significance at 28 days was reported using methods from the original, previously published article. RESULTS Pretreatment average phantom and residual pain scores were balanced between the groups. The day after infusion initiation (day 1), average phantom, and residual limb pain intensity was lower in patients receiving local anesthetic (n = 71) versus placebo (n = 73): median [quartiles] of 0 [0-2.5] vs 3.3 [0-5.0], median difference (98.75% confidence interval [CI]) of -1.0 (-3.0 to 0) for phantom pain (P = .001) and 0 [0-0] vs 0 [0-4.3], and median difference 0.0 (-2.0 to 0.0) for residual limb pain (P < .001). Pain's interference with physical and emotional functioning as measured with the interference domain of the Brief Pain Inventory improved during the infusion on day 1 for patients receiving local anesthetic versus placebo: 0 [0-10] vs 10 [0-40], median difference (98.75% CI) of 0.0 (-16.0 to 0.0), P = .002. Following infusion discontinuation (day 6), a few differences were found between the active and placebo treatment groups between days 7 and 21. In general, sample medians for average phantom and residual limb pain scores gradually increased after catheter removal for both treatments, but to a greater degree in the control group until day 28, at which time the differences between the groups returned to statistical significance. CONCLUSIONS This secondary analysis suggests that a continuous Peripheral Nerve Block decreases phantom and residual limb pain during the infusion, although few improvements were again detected until day 28, 3 weeks following catheter removal.
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evaluation of trends in continuous Peripheral Nerve Block utilization for total knee arthroplasty within and outside the veterans affairs healthcare system
Regional Anesthesia and Pain Medicine, 2021Co-Authors: Harika Nagavelli, Stavros G Memtsoudis, Edward R Mariano, Vijay Krishnamoorthy, Neil Ray, Hunglun Hsia, Alan R Ellis, William E Bryan, Marc J Pepin, Karthik RaghunathanAbstract:Acute pain after total knee arthroplasty (TKA) may be moderate to severe for over a week and may lead to chronic pain.[1][1] Continuous Peripheral Nerve Block (CPNB) techniques have been recommended by guidelines as a non-opioid modality to provide titratable pain relief of extended duration.[2][2]
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a comparison of strength for two continuous Peripheral Nerve Block catheter dressings
Korean Journal of Anesthesiology, 2016Co-Authors: Lindsay Borg, Edward R Mariano, Steven K Howard, Edward T Kim, Lauren Steffel, Cynthia ShumAbstract:Background: Despite the benefits of continuous Peripheral Nerve Blocks, catheter dislodgment remains a major problem, especially in the ambulatory setting. However, catheter dressing techniques to prevent such dislodgment have not been studied rigorously. We designed this simulation study to test the strength of two commercially available catheter dressings. Methods: Using a cadaver model, we randomly assigned 20 trials to one of two dressing techniques applied to the lateral thigh: 1) clear adhesive dressing alone, or 2) clear adhesive dressing with an anchoring device. Using a digital luggage scale attached to a loop secured by the dressing, the same investigator applied steadily increasing force with a downward trajectory towards the floor until the dressing was removed or otherwise disrupted. Results: The weight, measured (median [10th–90th percentile]) at the time of dressing disruption or removal, was 1.5 kg (1.3–1.8 kg) with no anchoring device versus 4.9 kg (3.7–6.5 kg) when the dressing included an anchoring device (P < 0.001). Conclusions: Based on this simulation study, using an anchoring device may help prevent perineural catheter dislodgement and therefore premature disruption of continuous Nerve Block analgesia.
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the effects of varying local anesthetic concentration and volume on continuous popliteal sciatic Nerve Blocks a dual center randomized controlled study
Anesthesia & Analgesia, 2008Co-Authors: Brian M Ilfeld, Vanessa J Loland, J C Gerancher, Anupama Wadhwa, Elizabeth M Renehan, Daniel I Sessler, Jonathan J Shuster, Douglas W Theriaque, Rosalita C Maldonado, Edward R MarianoAbstract:BACKGROUND:It remains unknown whether local anesthetic concentration, or simply total drug dose, is the primary determinant of continuous Peripheral Nerve Block effects. We therefore tested the null hypothesis that providing different concentrations and rates of ropivacaine, but at equal total doses
Brian M Ilfeld - One of the best experts on this subject based on the ideXlab platform.
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immediate effects of a continuous Peripheral Nerve Block on postamputation phantom and residual limb pain secondary outcomes from a multicenter randomized controlled clinical trial
Anesthesia & Analgesia, 2021Co-Authors: Brian M Ilfeld, Edward R Mariano, Bahareh Khatibi, Kamal Maheshwari, Sarah J Madison, Wael Ali Sakr Esa, Michael L KentAbstract:BACKGROUND We recently reported that a 6-day continuous Peripheral Nerve Block reduced established postamputation phantom pain 3 weeks after treatment ended. However, the immediate effects of perineural infusion (secondary outcomes) have yet to be reported. METHODS Participants from 5 enrolling academic centers with an upper or lower limb amputation and established phantom pain received a single-injection ropivacaine Peripheral Nerve Block(s) and perineural catheter insertion(s). They were subsequently randomized to receive a 6-day ambulatory perineural infusion of either ropivacaine 0.5% or normal saline in a double-masked fashion. Participants were contacted by telephone 1, 7, 14, 21, and 28 days after the infusion started, with pain measured using the Numeric Rating Scale. Treatment effects were assessed using the Wilcoxon rank-sum test at each time point. Adjusting for 4 time points (days 1, 7, 14, and 21), P < .0125 was deemed statistically significant. Significance at 28 days was reported using methods from the original, previously published article. RESULTS Pretreatment average phantom and residual pain scores were balanced between the groups. The day after infusion initiation (day 1), average phantom, and residual limb pain intensity was lower in patients receiving local anesthetic (n = 71) versus placebo (n = 73): median [quartiles] of 0 [0-2.5] vs 3.3 [0-5.0], median difference (98.75% confidence interval [CI]) of -1.0 (-3.0 to 0) for phantom pain (P = .001) and 0 [0-0] vs 0 [0-4.3], and median difference 0.0 (-2.0 to 0.0) for residual limb pain (P < .001). Pain's interference with physical and emotional functioning as measured with the interference domain of the Brief Pain Inventory improved during the infusion on day 1 for patients receiving local anesthetic versus placebo: 0 [0-10] vs 10 [0-40], median difference (98.75% CI) of 0.0 (-16.0 to 0.0), P = .002. Following infusion discontinuation (day 6), a few differences were found between the active and placebo treatment groups between days 7 and 21. In general, sample medians for average phantom and residual limb pain scores gradually increased after catheter removal for both treatments, but to a greater degree in the control group until day 28, at which time the differences between the groups returned to statistical significance. CONCLUSIONS This secondary analysis suggests that a continuous Peripheral Nerve Block decreases phantom and residual limb pain during the infusion, although few improvements were again detected until day 28, 3 weeks following catheter removal.
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clinical effectiveness of liposomal bupivacaine administered by infiltration or Peripheral Nerve Block to treat postoperative pain
Anesthesiology, 2021Co-Authors: Brian M Ilfeld, James C Eisenach, Rodney A GabrielAbstract:The authors provide a comprehensive summary of all randomized, controlled trials (n = 76) involving the clinical administration of liposomal bupivacaine (Exparel; Pacira Pharmaceuticals, USA) to control postoperative pain that are currently published. When infiltrated surgically and compared with unencapsulated bupivacaine or ropivacaine, only 11% of trials (4 of 36) reported a clinically relevant and statistically significant improvement in the primary outcome favoring liposomal bupivacaine. Ninety-two percent of trials (11 of 12) suggested a Peripheral Nerve Block with unencapsulated bupivacaine provides superior analgesia to infiltrated liposomal bupivacaine. Results were mixed for the 16 trials comparing liposomal and unencapsulated bupivacaine, both within Peripheral Nerve Blocks. Overall, of the trials deemed at high risk for bias, 84% (16 of 19) reported statistically significant differences for their primary outcome measure(s) compared with only 14% (4 of 28) of those with a low risk of bias. The preponderance of evidence fails to support the routine use of liposomal bupivacaine over standard local anesthetics.
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the effects of varying local anesthetic concentration and volume on continuous popliteal sciatic Nerve Blocks a dual center randomized controlled study
Anesthesia & Analgesia, 2008Co-Authors: Brian M Ilfeld, Vanessa J Loland, J C Gerancher, Anupama Wadhwa, Elizabeth M Renehan, Daniel I Sessler, Jonathan J Shuster, Douglas W Theriaque, Rosalita C Maldonado, Edward R MarianoAbstract:BACKGROUND:It remains unknown whether local anesthetic concentration, or simply total drug dose, is the primary determinant of continuous Peripheral Nerve Block effects. We therefore tested the null hypothesis that providing different concentrations and rates of ropivacaine, but at equal total doses
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development of a standardized Peripheral Nerve Block procedure note form
Regional Anesthesia and Pain Medicine, 2005Co-Authors: J C Gerancher, Brian A Williams, Brian M Ilfeld, Eugene R Viscusi, Gregory A Liguori, Colin J L Mccartney, Stuart A Grant, James R Hebl, Admir HadzicAbstract:Objectives: Despite the tremendous growth of Peripheral Nerve Blocks, no standard format exists to document their performance. Our objective was to create a Peripheral Nerve Block form based on key elements of literature evidence and on our own group consensus. Results: We describe the process and results of our multi-institutional effort to construct a standardized Peripheral Nerve Block procedure form. Conclusion: A form was developed to help meet the medical, legal, and billing requirements of documentation consistent with the performance of Peripheral Nerve Block.
James R Hebl - One of the best experts on this subject based on the ideXlab platform.
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a pre emptive multimodal pathway featuring Peripheral Nerve Block improves perioperative outcomes after major orthopedic surgery
Regional Anesthesia and Pain Medicine, 2008Co-Authors: James R Hebl, John A Dilger, David E Byer, Sandra L Kopp, Susanna R Stevens, Mark W Pagnano, Arlen D Hanssen, Terese T HorlockerAbstract:Background and Objectives: Patients undergoing major orthopedic surgery experience significant postoperative pain. Failure to provide adequate analgesia may impede early physical therapy and rehabilitation, which are important factors for maintaining joint range of motion and facilitating hospital dismissal. We examined the effect of a pre-emptive, multimodal, perioperative analgesic regimen emphasizing Peripheral Nerve Block in patients undergoing total hip (THA) and total knee (TKA) arthroplasty. Perioperative outcomes and major postoperative complications were evaluated. Methods: One hundred consecutive patients undergoing primary or revision THA or TKA using the Mayo Clinic Total Joint Regional Anesthesia (TJRA) protocol were retrospectively reviewed. The TJRA protocol is a pre-emptive, multimodal, perioperative analgesic regimen emphasizing Peripheral Nerve Block that was jointly developed by the Departments of Anesthesiology and Orthopedic Surgery. Identified patients were matched 1:1 with historical controls undergoing identical surgical procedures with traditional anesthetic techniques. Matching criteria included patient age, gender, surgeon, date of surgery, and American Society of Anesthesiologists physical status. Patient demographics, preoperative joint range of motion, and anesthetic management were recorded for each patient. The primary study outcome was hospital length of stay. Secondary outcome variables included time to ambulation, joint range of motion, and discharge eligibility. Postoperative verbal analog pain scores (VAS), opioid requirements, side effects, and perioperative complications were also documented. Results: One hundred patients underwent THA or TKA using the newly implemented Mayo Clinic TJRA protocol. Matched controls (n = 100) received intravenous patient-controlled analgesia with subsequent conversion to oral analgesics for postoperative pain management. TJRA patients had significantly shorter hospital lengths of stay (3.8 days v 5.0 days; P Conclusions: Patients undergoing THA or TKA using a comprehensive, pre-emptive, multimodal analgesic regimen emphasizing Peripheral Nerve Block may have significantly improved perioperative outcomes, and fewer adverse events, when compared with patients receiving traditional intravenous opioids during the initial postoperative period. Improved perioperative outcomes include a shortened hospital length of stay, and a significant reduction in postoperative urinary retention and ileus formation.
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analgesia for total hip and knee arthroplasty a multimodal pathway featuring Peripheral Nerve Block
Journal of The American Academy of Orthopaedic Surgeons, 2006Co-Authors: Terese T Horlocker, Mark W Pagnano, Sandra L Kopp, James R HeblAbstract:Abstract Patients undergoing total hip and knee arthroplasty experience substantial and sustained postoperative pain. Inadequate analgesia may impede physical therapy and rehabilitative efforts and delay hospital dismissal. Traditionally, postoperative analgesia after total joint replacement was provided by either intravenous patient-controlled analgesia or epidural analgesia. Each, however, had disadvantages as well as advantages. Peripheral Nerve Blockade of the lumbosacral plexus has emerged as an alternative analgesic approach. In several studies, unilateral Peripheral Block provided a quality of analgesia and functional outcomes similar to those of continuous epidural analgesia and superior to those of systemic analgesia, but with fewer side effects because of their opioid-sparing properties. Peripheral Nerve Block techniques may be the optimal analgesic method following total joint arthroplasty.
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development of a standardized Peripheral Nerve Block procedure note form
Regional Anesthesia and Pain Medicine, 2005Co-Authors: J C Gerancher, Brian A Williams, Brian M Ilfeld, Eugene R Viscusi, Gregory A Liguori, Colin J L Mccartney, Stuart A Grant, James R Hebl, Admir HadzicAbstract:Objectives: Despite the tremendous growth of Peripheral Nerve Blocks, no standard format exists to document their performance. Our objective was to create a Peripheral Nerve Block form based on key elements of literature evidence and on our own group consensus. Results: We describe the process and results of our multi-institutional effort to construct a standardized Peripheral Nerve Block procedure form. Conclusion: A form was developed to help meet the medical, legal, and billing requirements of documentation consistent with the performance of Peripheral Nerve Block.
Stephen M Klein - One of the best experts on this subject based on the ideXlab platform.
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changes in brain resting state functional connectivity associated with Peripheral Nerve Block a pilot study
Anesthesiology, 2016Co-Authors: Stephen M Melton, Karen C Nielsen, Jeffrey N Browndyke, Todd B Harshbarger, David J Madden, Stephen M KleinAbstract:Background: Limited information exists on the effects of temporary functional deafferentation (TFD) on brain activity after Peripheral Nerve Block (PNB) in healthy humans. Increasingly, resting-state functional connectivity (RSFC) is being used to study brain activity and organization. The purpose of this study was to test the hypothesis that TFD through PNB will influence changes in RSFC plasticity in central sensorimotor functional brain networks in healthy human participants. Methods: The authors achieved TFD using a supraclavicular PNB model with 10 healthy human participants undergoing functional connectivity magnetic resonance imaging before PNB, during active PNB, and during PNB recovery. RSFC differences among study conditions were determined by multiple-comparison–corrected (false discovery rate–corrected P value less than 0.05) random-effects, between-condition, and seed-to-voxel analyses using the left and right manual motor regions. Results: The results of this pilot study demonstrated disruption of interhemispheric left-to-right manual motor region RSFC (e.g., mean Fisher-transformed z [effect size] at pre-PNB 1.05 vs. 0.55 during PNB) but preservation of intrahemispheric RSFC of these regions during PNB. Additionally, there was increased RSFC between the left motor region of interest (PNB-affected area) and bilateral higher order visual cortex regions after clinical PNB resolution (e.g., Fisher z between left motor region of interest and right and left lingual gyrus regions during PNB, −0.1 and −0.6 vs. 0.22 and 0.18 after PNB resolution, respectively). Conclusions: This pilot study provides evidence that PNB has features consistent with other models of deafferentation, making it a potentially useful approach to investigate brain plasticity. The findings provide insight into RSFC of sensorimotor functional brain networks during PNB and PNB recovery and support modulation of the sensory–motor integration feedback loop as a mechanism for explaining the behavioral correlates of Peripherally induced TFD through PNB.
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Peripheral Nerve Block techniques for ambulatory surgery
Anesthesia & Analgesia, 2005Co-Authors: Stephen M Klein, Karen C Nielsen, Marcy S Tucker, David S Warner, Holly Evans, Susan M SteeleAbstract:Peripheral Nerve Blocks (PNBs) have an increasingly important role in ambulatory anesthesia and have many characteristics of the ideal outpatient anesthetic: surgical anesthesia, prolonged postoperative analgesia, and facilitated discharge. Critically evaluating the potential benefits and supporting evidence is essential to appropriate technique selection. When PNBs are used for upper extremity procedures, there is consistent opioid sparing and fewer treatment-related side effects when compared with general anesthesia. This has been demonstrated in the immediate perioperative period but has not been extensively investigated after discharge. Lower extremity PNBs are particularly useful for procedures resulting in greater tissue trauma when the benefits of dense analgesia appear to be magnified, as evidenced by less hospital readmission. The majority of current studies do not support the concept that a patient will have difficulty coping with pain when their Block resolves at home. Initial investigations of outpatient continuous Peripheral Nerve Blocks demonstrate analgesic potential beyond that obtained with single-injection Blocks and offer promise for extending the duration of postoperative analgesia. The encouraging results of these studies will have to be balanced with the resources needed to safely manage catheters at home. Despite supportive data for ambulatory PNBs, most studies have been either case series or relatively small prospective trials, with a narrow focus on analgesia, opioids, and immediate side effects. Ultimately, having larger prospective data with a broader focus on outcome benefits would be more persuasive for anesthesiologists to perform procedures that are still viewed by many as technically challenging.
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continuous Peripheral Nerve Block for battlefield anesthesia and evacuation
Regional Anesthesia and Pain Medicine, 2005Co-Authors: Chester C Buckenmaier, Stephen M Klein, Geselle M Mcknight, James Winkley, Lisa L Bleckner, Clarence Shannon, Robert C Lyons, John H ChilesAbstract:Peripheral Nerve and continuous Peripheral Nerve Block (CPNB) have the potential to be valuable techniques in combat anesthesia. We describe the first successful application of CPNB in the pain management and surgical management of a combat casualty as he was evacuated from the Iraqi battlefield to the United States.
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continuous Peripheral Nerve Block for ambulatory surgery
Regional Anesthesia and Pain Medicine, 2001Co-Authors: Stuart A Grant, Karen C Nielsen, Susan M Steele, Roy A Greengrass, Stephen M KleinAbstract:Abstract Background and Objectives: Continuous Peripheral Nerve Block (CPNB) can provide surgical anesthesia, prolonged postoperative analgesia, and acceptable side effects. Despite these advantages, CPNB is not in widespread use. Recently a new CPNB catheter system (Contiplex, B. Braun, Bethlehem, PA) was developed based on an insulated Tuohy needle, which allows for injection of local anesthetic and catheter insertion without disconnection or needle movement. At present, no clinical studies exist describing this system. Methods: Data were prospectively gathered for 1 year from 228 patients in an ambulatory surgery center. All CPNB were performed using the Contiplex system to provide anesthesia and postoperative analgesia. CPNB were performed using 5 upper and lower extremity techniques. Postsurgery local anesthetic was infused and at 24 hours, a rebolus of local anesthetic was performed. The CPNB catheter was removed and patients were examined for loss of sensation. Patients were then discharged. Results: Initial Peripheral Block was successful in 94% of patients. Failed Nerve Block requiring general anesthesia occurred in 6%. The catheter was patent and functional in 90% of patients at 24 hours, and 8% of patients required more than 10 mg of intravenous morphine by 24 hours postsurgery. In the postanesthesia care unit (PACU), only 4 patients (1.7%) required treatment for nausea. At 24 hours and 7 days postsurgery, no patient reported a dysesthesia. Conclusions: CPNB using the insulated Tuohy catheter system offered acceptable anesthesia and prolonged pain relief postsurgery. There were few side effects. Reg Anesth Pain Med 2001;26:209-214.
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interscalene brachial plexus Block with a continuous catheter insertion system and a disposable infusion pump
Anesthesia & Analgesia, 2000Co-Authors: Stephen M Klein, Karen C Nielsen, David S Warner, Stuart A Grant, Roy A Greengrass, Kevin P Speer, William D White, Susan M SteeleAbstract:Continuous interscalene brachial plexus Blockade traditionally requires a hospital stay for local anesthetic infusion, and achieving consistent catheter insertion may be difficult. Incorporating long-acting pain relief from a continuous Peripheral Nerve Block, with a reliable method of catheter inse
Susan M Steele - One of the best experts on this subject based on the ideXlab platform.
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Peripheral Nerve Block techniques for ambulatory surgery
Anesthesia & Analgesia, 2005Co-Authors: Stephen M Klein, Karen C Nielsen, Marcy S Tucker, David S Warner, Holly Evans, Susan M SteeleAbstract:Peripheral Nerve Blocks (PNBs) have an increasingly important role in ambulatory anesthesia and have many characteristics of the ideal outpatient anesthetic: surgical anesthesia, prolonged postoperative analgesia, and facilitated discharge. Critically evaluating the potential benefits and supporting evidence is essential to appropriate technique selection. When PNBs are used for upper extremity procedures, there is consistent opioid sparing and fewer treatment-related side effects when compared with general anesthesia. This has been demonstrated in the immediate perioperative period but has not been extensively investigated after discharge. Lower extremity PNBs are particularly useful for procedures resulting in greater tissue trauma when the benefits of dense analgesia appear to be magnified, as evidenced by less hospital readmission. The majority of current studies do not support the concept that a patient will have difficulty coping with pain when their Block resolves at home. Initial investigations of outpatient continuous Peripheral Nerve Blocks demonstrate analgesic potential beyond that obtained with single-injection Blocks and offer promise for extending the duration of postoperative analgesia. The encouraging results of these studies will have to be balanced with the resources needed to safely manage catheters at home. Despite supportive data for ambulatory PNBs, most studies have been either case series or relatively small prospective trials, with a narrow focus on analgesia, opioids, and immediate side effects. Ultimately, having larger prospective data with a broader focus on outcome benefits would be more persuasive for anesthesiologists to perform procedures that are still viewed by many as technically challenging.
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continuous Peripheral Nerve Block for ambulatory surgery
Regional Anesthesia and Pain Medicine, 2001Co-Authors: Stuart A Grant, Karen C Nielsen, Susan M Steele, Roy A Greengrass, Stephen M KleinAbstract:Abstract Background and Objectives: Continuous Peripheral Nerve Block (CPNB) can provide surgical anesthesia, prolonged postoperative analgesia, and acceptable side effects. Despite these advantages, CPNB is not in widespread use. Recently a new CPNB catheter system (Contiplex, B. Braun, Bethlehem, PA) was developed based on an insulated Tuohy needle, which allows for injection of local anesthetic and catheter insertion without disconnection or needle movement. At present, no clinical studies exist describing this system. Methods: Data were prospectively gathered for 1 year from 228 patients in an ambulatory surgery center. All CPNB were performed using the Contiplex system to provide anesthesia and postoperative analgesia. CPNB were performed using 5 upper and lower extremity techniques. Postsurgery local anesthetic was infused and at 24 hours, a rebolus of local anesthetic was performed. The CPNB catheter was removed and patients were examined for loss of sensation. Patients were then discharged. Results: Initial Peripheral Block was successful in 94% of patients. Failed Nerve Block requiring general anesthesia occurred in 6%. The catheter was patent and functional in 90% of patients at 24 hours, and 8% of patients required more than 10 mg of intravenous morphine by 24 hours postsurgery. In the postanesthesia care unit (PACU), only 4 patients (1.7%) required treatment for nausea. At 24 hours and 7 days postsurgery, no patient reported a dysesthesia. Conclusions: CPNB using the insulated Tuohy catheter system offered acceptable anesthesia and prolonged pain relief postsurgery. There were few side effects. Reg Anesth Pain Med 2001;26:209-214.
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interscalene brachial plexus Block with a continuous catheter insertion system and a disposable infusion pump
Anesthesia & Analgesia, 2000Co-Authors: Stephen M Klein, Karen C Nielsen, David S Warner, Stuart A Grant, Roy A Greengrass, Kevin P Speer, William D White, Susan M SteeleAbstract:Continuous interscalene brachial plexus Blockade traditionally requires a hospital stay for local anesthetic infusion, and achieving consistent catheter insertion may be difficult. Incorporating long-acting pain relief from a continuous Peripheral Nerve Block, with a reliable method of catheter inse