Regional Catheters for Postoperative Pain Control: Review and Observational Data

Abstract

Context: Perioperative analgesia is an essential but frequently underrated component of medical care. The purpose of this work is to describe the actual situation of surgical patients focusing on effective pain control by discarding prejudice against 'aggressive' measures. Evidence Acquisition: This is a narrative review about continuous regional pain therapy with catheters in the postoperative period. Included are the most-relevant literature as well as own experiences. Results: As evidenced by an abundance of studies, continuous regional/neuraxial blocks are the most effective approach for relief of severe postoperative pain. Catheters have to be placed in adequate anatomical positions and meticulously maintained as long as they remain in situ. Peripheral catheters in interscalene, femoral, and sciatic positions are effective in patients with surgery of upper and lower limbs. Epidural catheters are effective in abdominal and thoracic surgery, birth pain, and artery occlusive disease, whereas paravertebral analgesia may be beneficial in patients with unilateral approach of the truncus. However, failure rates are high, especially for epidural catheter analgesia. Unfortunately, many reports lack a comprehensive description of catheter application, management, failure rates and complications and thus cannot be compared with each other. Conclusions: Effective control of postoperative pain is possible by the application of regional/neuraxial catheters, measures requiring dedication, skill, effort, and funds. Standard operating procedures contribute to minimizing complications and adverse side effects. Nevertheless, these methods are still not widely accepted by therapists, although more than 50% of postoperative patients suffer from 'moderate, severe or worst' pain.

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

“…These dynamics preclude strong recommendations or expert consensus regarding their use [ 251 , 252 ]. Alternatively, continuous catheters are effective strategies for extending local anesthetic analgesia, and are supported by clinical practice guidelines when the duration of analgesia is expected to exceed the capacity of single-injection nerve blocks [ 15 , 255 , 256 ]. Continuous catheters are not without limitations, however, including increased complexity to perform and maintain, catheter-related complications, and additional monitoring and follow-up requirements [ 249 ].…”

Adjuvant Drugs for Peripheral Nerve Blocks: The Role of NMDA Antagonists, Neostigmine, Epinephrine, and Sodium Bicarbonate

“…Despite improvements in technique, peripheral nerve blocks are limited by the duration of action (6). Continuous peripheral nerve blocks (CPNB) provide long-term pain control via the transcutaneous insertion of a catheter to the targeted nerve or plexus through which local anesthetic can be infused (7). Although CPNB provides an effective alternative for longterm pain management, disadvantages of cost, difficulty in insertion, and morbidity with catheter-associated infections and incidental dislodgement often outweigh its advantages (8).…”

Colocación de catéter ecoguiado para bloqueo PENG continuo en Cirugía de Cadera

“…Debido a las ventajas del bloqueo PENG previamente mencionadas, las indicaciones para su uso se pueden ampliar a múltiples escenarios, desde la analgesia para cirugías de cadera o la reducción de luxación coxofemoral, analgesia en fracturas de fémur, hasta prevenir el espasmo de los músculos abductores, analgesia postoperatoria en varicocelectomía, cirugía de glúteo, control del dolor crónico y «on arrival block», entre otros; ya sea como técnica única o como parte del manejo multimodal aunado a anestesia general u otras técnicas de anestesia regional. El objetivo de este reporte fue describir la posibilidad de prolongar la analgesia postoperatoria de 12 a 24 o 48 horas con la colocación de un catéter debajo del tendón del psoas (4) .…”