Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewSpinal anaesthesia: local anaesthetics and adjuncts in the ambulatory setting.
Intrathecal lidocaine remains a popular choice for ambulatory spinal anaesthesia due to its reliability, rapid onset and predictable rapid recovery profile. However, concerns with transient neurological symptoms (TNS) and their significant association with lidocaine have generated interest in alternative local anaesthetic agents to provide adequate spinal anaesthesia with the briefest possible recovery period. ⋯ Controversies regarding the possible lower risk of TNS with newer spinal anaesthetic techniques and new discharge criteria are reviewed. The final section provides technical pearls to optimize ambulatory spinal anaesthetic outcomes.
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Early and efficient rehabilitation is necessary for improving outcome after shoulder surgery. Pain, which is severe to very severe in this condition, is the major factor which compromises early physical therapy. Interscalene block is a well recognized and efficient technique for controlling pain after major open shoulder surgery. ⋯ However, the application of a continuous infusion of local anaesthetics through an interscalene catheter is actually the best technique available to achieve pain relief at rest and on movement after this type of surgery. This chapter emphasizes the advantages of the modified lateral approach, the use of patient-controlled interscalene analgesia and the traps and tricks of the interscalene block. Thus, this chapter demonstrates why interscalene anaesthesia and analgesia are the most appropriate techniques for shoulder surgery.
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Surgical procedures of the knee are increasingly common in outpatient centres. Advances in arthroscopy and other technologies allow more complex knee procedures to be performed on an outpatient basis. ⋯ Specific nerve blocks and local anaesthetics suitable for various knee procedures are discussed. The use of perineural catheters in the outpatient management of major knee surgery patients is also considered.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewOutcome after regional anaesthesia in the ambulatory setting--is it really worth it?
Regional anaesthesia provides a continuum of perioperative care that includes perioperative pain management, decreased opioid requirements and decreased post-operative nausea and vomiting. In addition to these benefits, a wide variety of perioperative outcomes can be enhanced by utilizing regional anaesthesia in the ambulatory setting. ⋯ In addition, regional anaesthesia can facilitate early recovery with excellent post-operative analgesia and few side-effects, which may decrease overall operative costs. This chapter identifies important perioperative outcomes that may be positively influenced by the use of regional anaesthesia in the ambulatory setting.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewParavertebral anaesthesia/analgesia for ambulatory surgery.
For many years, paravertebral nerve blockade has been an established technique for providing analgesia to the chest and abdomen. The current emphasis on containment of health care costs has resulted in a rediscovery of anaesthetic techniques, such as paravertebral blocks, that facilitate outpatient surgical management and promote early discharge. ⋯ Continuous paravertebral catheters, pharmacological agents used in PVB, and single versus multiple injection paravertebral block techniques are also covered. Specific clinical situations that are particularly well suited to the application of PVB as the primary anaesthetic in the ambulatory setting and other clinical situations where analgesia from PVB is efficacious are discussed.