© Cambridge University Press, 2009 and Raymond S. Sinatra, Oscar A. de Leon-Casasola, Brian Ginsberg, Eugene R. Viscusi 2009. Surgery of the upper and lower limbs presents anesthesiologists with an alternative to general anesthesia, that being regional anesthesia. Even if we do not utilize a regional technique for anesthesia we certainly can do so for postoperative analgesia. For years neuroaxial techniques were used as the sole regional anesthetic of choice for the lower limb. The advent of lowmolecular-weight heparins (eg, enoxaparin, fondaparinux) and the potential risk for the development of epidural hematomas has severely limited their use and led to a much higher use of peripheral nerve blocks in everyday practice. Since the mid-2000s, great improvements have been made in the equipment used to perform peripheral nerve blocks, including stimulating peripheral nerve catheters and the use of ultrasound to identify nerves. In addition, recent literature has shown a growing body of evidence supporting the benefit of regional anesthesia versus general anesthesia with respect to mortality, morbidity, postoperative analgesia, and functional recovery. In a metaanalysis study, Rodgers et al showed a reduction in mortality of 33%. They also showed a significant decrease in the incidence of myocardial ischemic events, respiratory depression, rate of deep vein thrombosis (DVT) formation, and blood loss. Adequate pain management following surgery using a multimodal technique, including the use of cycloxygenase-2 inhibitors (COX- 2 inhibitors), pregabalin or gabapentin, and peripheral nerve blocks, plays an important role in the management of acute postoperative pain and possibly the prevention of subsequent chronic pain syndromes.
Benonis, J; Fortney, J; Hardman, D; Martin, G
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International Standard Book Number 13 (ISBN-13)
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