Best practice & research. Clinical anaesthesiology
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This article reviews the current evidence for multimodal analgesic options for common surgical procedures. As perioperative physicians, we have come a long way from using only opioids for postoperative pain to combinations of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), selective Cyclo-oxygenase (COX-2) inhibitors, local anesthetics, N-methyl-d-aspartate (NMDA) receptor antagonists, and regional anesthetics. As discussed in this article, many of these agents have decreased narcotic requirements, improved patient satisfaction, and decreased postanesthesia care unit (PACU) times, as well as morbidity in the perioperative period.
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Best Pract Res Clin Anaesthesiol · Mar 2014
ReviewUltrasound and its evolution in perioperative regional anesthesia and analgesia.
Perioperative regional anesthetic and analgesic techniques have evolved considerably over the past four decades. Perhaps, the most impressive development in recent years has been the rapid adoption and widespread utilization of ultrasound (US) guidance to perform targeted delivery of local anesthetics and catheters in a consistent manner for postoperative pain control. This article briefly reviews the history of US in regional anesthesia and perioperative analgesia, the evidence basis for this practice, the clinical application of novel techniques and imaging modalities, and possible future technology and research directions.
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Best Pract Res Clin Anaesthesiol · Mar 2014
Review Comparative StudyLiposomal bupivacaine and clinical outcomes.
In the multimodal approach to the management of postoperative pain, local infiltration and regional blocks have been increasingly utilized for pain control. One of the limitations of local anesthetics in the postoperative setting is its relatively short duration of action. Multivesicular liposomes containing bupivacaine have been increasingly utilized for their increased duration of action. ⋯ In this article, we attempt to review the clinical literature surrounding liposomal bupivacaine and its evolving role in perioperative analgesia. This new bupivacaine formation may have promising implications in postoperative pain control, resulting in increased patient satisfaction and a decrease in both hospital stay and opioid-induced adverse events (AEs). Although more studies are needed, the preliminary clinical trials suggest that liposomal bupivacaine has predictable pharmacokinetics, a similar side effect profile compared with bupivacaine HCl, and is effective in providing increased postoperative pain control.