Upper-Extremity Peripheral Nerve Blocks in the Perioperative Pain Management of Orthopaedic Patients

Abstract

The use of peripheral nerve blocks in upper-extremity surgery is common. To actively participate with the patient and anesthesiologist to ensure the best possible outcomes, the orthopaedic surgeon must be well informed regarding the benefits and limitations of this modality.

Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes

“…Regional anesthesia has experienced a rise in popularity across all surgical specialties over the past several decades as the number of ambulatory procedures being performed and scrutiny of hospital resource utilization has increased [46,47]. Proponents emphasize better pain control, decreased systemic opioid requirements and a safer side effect profile with reductions in respiratory complications and venous thromboembolic events [12,46,47].…”

Peri-operative Pain Management in Chronic Opioid Users and Unhabituated Patients

“…43,44,56,57 Regional anesthesia can involve neuraxial (central) or peripheral blockade. In general, central neuraxial blocks alone or in combination with catheter techniques provide better pain control.…”

Pain Management Strategies in Hand Surgery

“…Traditionally the patient's pain is managed with general anesthesia and narcotic medication for surgery, followed by oral medications, including acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), opioid-containing oral analgesics (e.g., codeine-acetaminophen), or a combination of these along with intravenous pain medications (including patient-controlled analgesia), after surgery 9 . Despite the availability of these analgesic drugs, many patients still do not achieve effective pain control 10 , often times because adverse gastrointestinal, hemostatic, and renal effects that become prohibitive to achieving adequate analgesic concentrations.…”

“…Overall peripheral nerve blocks can offer cost effective pain control for patients undergoing upper extremity procedures and have the potential to minimize need for narcotic use, shorten hospital stays and increase patient satisfaction 9 .…”

“…Richard et al 78 , performed single-dose toxicology studies of 3 doses of Exparil (9,18, and 30mg/kg), and compared them to bupivacaine solution (9 mg/kg) and saline. When these were injected around the brachial plexus nerve bundle of rabbits and dogs, they found that at the same dose, Exparel resulted in a 4-fold lower maximum plasma concentration of bupivacaine and was well tolerated at all doses.…”