Best practice & research. Clinical anaesthesiology
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Incisional and intra-articular local anaesthetic techniques are simple, safe and inexpensive analgesic methods for the management of post-operative pain following a variety of surgical procedures. These techniques are capable of providing effective analgesia over a limited field and with minimal systemic effects. ⋯ The incisional and intra-articular use of opioids and several non-opioids, either alone or in combination with local anaesthetics, has also been evaluated. This chapter reviews the current status of single dose and infusions of local anaesthetics and adjuvants for incisional and intra-articular analgesic techniques and also looks at future perspectives.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewSingle-injection applications for foot and ankle surgery.
Foot or ankle surgery is often performed in an ambulatory care setting. The post-operative pain that follows can be moderate to severe in intensity and difficult to control with oral analgesics. Regional anaesthetic techniques have been advocated for such procedures. ⋯ Patients can be safely discharged even when long-acting local anaesthetics are used. In major surgery a continuous technique can be proposed. When the prone position is impossible the lateral approach is an efficient alternative.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewPaediatric regional anaesthesia--what makes a difference?
Regional anaesthetic techniques are useful for providing post-operative pain control for ambulatory surgery in children. This chapter focuses on unique features of paediatric anatomy and physiology that allow successful performance of these techniques. ⋯ Combinations of local anaesthetics and adjunct medications that prolong caudal blockade, the most commonly performed paediatric block, are reviewed, with a goal of providing prolonged analgesia with minimal side-effects. An overview of the use of peripheral nerve blockade and specific recommendations for the use of these blocks in children is also presented.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewMajor surgery in the ambulatory environment: continuous catheters and home infusions.
The ability to provide continuous peripheral nerve blocks to patients safely on an outpatient basis has been a major advance in ambulatory surgery over the past several years. The first reports of patients self-administering local anaesthetic via wound and perineural catheters were published in 1998. Such infusions have now become a necessary component for the success of various ambulatory procedures. ⋯ Many of the concepts used to provide safe ambulatory infusion have been drawn from studies of patients receiving these types of therapies in a hospital setting. Few studies have actually examined these techniques is an outpatient environment. However, the advantages of these analgesic techniques over traditional oral narcotics for patients undergoing major surgery in the ambulatory environment have led to their rapid acceptance as a standard of care at many institutions.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewThe Holy Grail: long-acting local anaesthetics and liposomes.
The ability to provide an extended duration of analgesia of days following a single injection without the need for catheters, pumps and infusion systems would be a great benefit in acute and chronic pain. Exciting progress is being made in our ability to combine local anaesthetics with liposomes and polymer microspheres. These interesting formulations in animal models have allowed up to 4 days of analgesia. Their use clinically will be a great advance which could possibly occur in the near future.