Understanding Anesthesiology - The Global Regional Anesthesia ...

lead to a decreased stress response to surgery, improved
post-operative pulmonary function and in high
risk patients, decreased cardiac morbidity. Successful
management relies on proper patient selection, appropriate
catheter placement (depending on the level of
the surgical site), adequate post-operative monitoring
and specific training of personnel to identify and treat
complications (including inadequate analgesia).
Epidural analgesia is commonly used after major intraabdominal
or thoracic surgery. A common use would
be following (open) abdominal aortic aneurysm repair
where the catheter might be left in for 48-72 hours. Occasionally,
the need for post-operative thrombosis prophylaxis
triggers the removal of the catheter as catheters
should not be removed or left indwelling in the anticoagulated
patient.
Peripheral Nerve Blocks
Almost any peripheral nerve that can be reached with a
needle can be blocked with local anesthetics. The brachial
plexus, intercostal and femoral nerves are examples
of nerves which are commonly blocked to provide
post-operative analgesia. A block may be used as the
sole method of post-operative analgesia or it may be
useful as an adjunct to decrease the required dose of
systemic opioids. Some peripheral nerve sites (e.g. the
brachial plexus) lend themselves to the insertion of
catheters for the continuous infusion of local anesthetics.
In the absence of catheter insertion, the major drawback
of this method of post-operative analgesia is that
the duration of effect of a single block is limited, usually
to less than 18 hours.
A typical example of the use of a peripheral nerve
block for post-operative pain would be the use of a
femoral/sciatic nerve block for a patient undergoing
total knee arthroplasty. The block would be augmented
with oral opioids and other adjuncts.
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