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Peripheral nerve block techniques for ambulatory surgery.

Publication ,  Journal Article
Klein, SM; Evans, H; Nielsen, KC; Tucker, MS; Warner, DS; Steele, SM
Published in: Anesth Analg
December 2005

Peripheral nerve blocks (PNBs) have an increasingly important role in ambulatory anesthesia and have many characteristics of the ideal outpatient anesthetic: surgical anesthesia, prolonged postoperative analgesia, and facilitated discharge. Critically evaluating the potential benefits and supporting evidence is essential to appropriate technique selection. When PNBs are used for upper extremity procedures, there is consistent opioid sparing and fewer treatment-related side effects when compared with general anesthesia. This has been demonstrated in the immediate perioperative period but has not been extensively investigated after discharge. Lower extremity PNBs are particularly useful for procedures resulting in greater tissue trauma when the benefits of dense analgesia appear to be magnified, as evidenced by less hospital readmission. The majority of current studies do not support the concept that a patient will have difficulty coping with pain when their block resolves at home. Initial investigations of outpatient continuous peripheral nerve blocks demonstrate analgesic potential beyond that obtained with single-injection blocks and offer promise for extending the duration of postoperative analgesia. The encouraging results of these studies will have to be balanced with the resources needed to safely manage catheters at home. Despite supportive data for ambulatory PNBs, most studies have been either case series or relatively small prospective trials, with a narrow focus on analgesia, opioids, and immediate side effects. Ultimately, having larger prospective data with a broader focus on outcome benefits would be more persuasive for anesthesiologists to perform procedures that are still viewed by many as technically challenging.

Duke Scholars

Published In

Anesth Analg

DOI

ISSN

0003-2999

Publication Date

December 2005

Volume

101

Issue

6

Start / End Page

1663 / 1676

Location

United States

Related Subject Headings

  • Spine
  • Sciatic Nerve
  • Peripheral Nerves
  • Nerve Block
  • Humans
  • Femur
  • Extremities
  • Brachial Plexus
  • Anesthesiology
  • Ambulatory Surgical Procedures
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Klein, S. M., Evans, H., Nielsen, K. C., Tucker, M. S., Warner, D. S., & Steele, S. M. (2005). Peripheral nerve block techniques for ambulatory surgery. Anesth Analg, 101(6), 1663–1676. https://doi.org/10.1213/01.ANE.0000184187.02887.24
Klein, Stephen M., Holly Evans, Karen C. Nielsen, Marcy S. Tucker, David S. Warner, and Susan M. Steele. “Peripheral nerve block techniques for ambulatory surgery.Anesth Analg 101, no. 6 (December 2005): 1663–76. https://doi.org/10.1213/01.ANE.0000184187.02887.24.
Klein SM, Evans H, Nielsen KC, Tucker MS, Warner DS, Steele SM. Peripheral nerve block techniques for ambulatory surgery. Anesth Analg. 2005 Dec;101(6):1663–76.
Klein, Stephen M., et al. “Peripheral nerve block techniques for ambulatory surgery.Anesth Analg, vol. 101, no. 6, Dec. 2005, pp. 1663–76. Pubmed, doi:10.1213/01.ANE.0000184187.02887.24.
Klein SM, Evans H, Nielsen KC, Tucker MS, Warner DS, Steele SM. Peripheral nerve block techniques for ambulatory surgery. Anesth Analg. 2005 Dec;101(6):1663–1676.

Published In

Anesth Analg

DOI

ISSN

0003-2999

Publication Date

December 2005

Volume

101

Issue

6

Start / End Page

1663 / 1676

Location

United States

Related Subject Headings

  • Spine
  • Sciatic Nerve
  • Peripheral Nerves
  • Nerve Block
  • Humans
  • Femur
  • Extremities
  • Brachial Plexus
  • Anesthesiology
  • Ambulatory Surgical Procedures