Peripheral Nerve Blocks for Postoperative Analgesia: From Traditional Unencapsulated Local Anesthetic to Liposomes, Cryoneurolysis and Peripheral Nerve Stimulation

Publication date: Available online 3 July 2019Source: Best Practice & Research Clinical AnaesthesiologyAuthor(s): Rodney A. Gabriel, Brian M. IlfeldAbstractPeripheral nerve blocks (PNB) using local anesthetics either via single injection or continuous perineural catheter have been the mainstay for regional anesthesia and are a vital component of postoperative multimodal opioid-sparing pain management. There are some limitations to PNBs, however, mainly its limited duration of action, but also risk of catheter-associated infection and dislodgements. Furthermore, local anesthetic-based blocks can induce sensory deficits and motor weakness, possibly increasing the risk of falling and/or decreasing the ability to participate in postoperative rehabilitation. In this review, we first discuss various local anesthetic-based PNB techniques for major surgery and then review newer modalities, including liposome bupivacaine, cryoanalgesia, and peripheral nerve stimulation; all of which may offer advantages over single and continuous local anesthetic-based PNBs.
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research