The Role of Continuous Peripheral Nerve Blocks

Abstract

A continuous peripheral nerve block (cPNB) is provided in the hospital and ambulatory setting. The most common use of CPNBs is in the peri- and postoperative period but different indications have been described like the treatment of chronic pain such as cancer-induced pain, complex regional pain syndrome or phantom limb pain. The documented benefits strongly depend on the analgesia quality and include decreasing baseline/dynamic pain, reducing additional analgesic requirements, decrease of postoperative joint inflammation and inflammatory markers, sleep disturbances and opioid-related side effects, increase of patient satisfaction and ambulation/functioning improvement, an accelerated resumption of passive joint range-of-motion, reducing time until discharge readiness, decrease in blood loss/blood transfusions, potential reduction of the incidence of postsurgical chronic pain and reduction of costs. Evidence deriving from randomized controlled trials suggests that in some situations there are also prolonged benefits of regional anesthesia after catheter removal in addition to the immediate postoperative effects. Unfortunately, there are only few data demonstrating benefits after catheter removal and the evidence of medium- or long-term improvements in health-related quality of life measures is still lacking. This review will give an overview of the advantages and adverse effects of cPNBs.

Physiologic Advantages of Peripheral Nerve Blockade Translate to Decreased Length of Stay and Improved Patient Satisfaction

“…9 A meta-analysis study in 2006 concluded that CPNBs provide superior pain control compared with opioids. 8 The study revealed significantly lower pain scores at multiple time points in patients with CPNBs. 8 The authors concluded that CPNBs can decrease health care expenses by reducing narcotic-related sideeffects.…”

“…Accordingly, continuous PNBs compared to single PNBs were associated with decreased pain ratings on postoperative days 0,1, and 2; decreased overall opioid use; decreased nausea; and higher patient satisfaction scores compared to single-and multiple-injection techniques ( Figure 2). 7,8 Continuous PNBs give physicians the flexibility to adapt to the differing pain thresholds of patients by dropping the volume or concentration of local anesthetic on initial dosing, which decreases the risk of systemic toxicity. Furthermore, by reducing the large initial doses, one is reducing the likelihood of motor and sensory blocks that have been associated with falls and positional injuries.…”

“…Indeed, PNBs protect against opioidinduced cardiovascular, respiratory, and gastrointestinal side effects. 8,12,13 Although continuous PNBs have been shown to be more efficacious in treating postoperative pain 9,12-28 and decreasing opioid use, single injection PNBs have been demonstrated to provide superior pain control and decreased side-effects compared to opioid monotherapy. 8,13 Altering the concentration of the local anesthetic used in the block can also modify narcotic consumption.…”

“…8,12,13 Although continuous PNBs have been shown to be more efficacious in treating postoperative pain 9,12-28 and decreasing opioid use, single injection PNBs have been demonstrated to provide superior pain control and decreased side-effects compared to opioid monotherapy. 8,13 Altering the concentration of the local anesthetic used in the block can also modify narcotic consumption. Aguirre et al 9 increased the concentration of ropivacaine in interscalene blocks for rotator cuff repairs and found significant reductions in morphine consumption.…”

Peripheral Nerve Blocks in Shoulder Arthroplasty: How Do They Influence Complications and Length of Stay?

“…Evidence is available that the use of regional anesthesia for orthopaedic surgery of the upper extremity conveys desirable advantages, including decreased baseline and dynamic pain, lower consumption of systemic analgesics, decrease of joint inflammation, increase in patient satisfaction, earlier mobilization, and shorter time to discharge readiness [1,14]. However, there is little knowledge on whether incidence of systemic complications, mortality, and resource utilization beyond earlier discharge are affected by the choice of anesthetic technique.…”