Continuous Peripheral Nerve Blocks

CONTINUOUS PERIPHERAL NERVE BLOCKS 1-Indications For Acute Pain MEDICINE 2-Equipment and Techniques - Stimulating Versus Nonstimulating catheters 3- Ultra Sound- Guided Catheter insertion _ Needle in-Plane, Nerve in Short-Axis Approach _ Needle out-of-Plane, Nerve in Short-Axis Approach _ Needle in-Plane and nerve in long-Axis Approach 4- infusion Management 5- Potential Risks /Complications

Indication 1- Prolongation intra operative surgical anesthesi 2- Induced sympathectomy and vasodilation 3- After Trauma (analgesia during Transportation) 4- Peripheral Regional analegesia way facilitate post operative Rehabilitation 5- outpatients (home) setting

E QUIPMENT AND TECHNIQUES STIMULATING VERSUS NONSTIMULATING CATHETERS Up to 40% of catheters have been reported misplaced upon insertion.

Ultra Sound- Guided Catheter insertion _ Needle in-Plane, Nerve in Short-Axis Approach _ Needle out-of-Plane, Nerve in Short-Axis Approach _ Needle in-Plane and nerve in long-Axis Approach

Needle In-Plane, Nerve in Short-Axis Approach: This is the most-frequently published single-injection peripheral nerve block orientation because this view allows for easier identification and differentiation from surrounding structures.

Infusion Management: Perineural infusion داروهایی که بصورت انفوزیون بکار می رود مثل: 1- Bupivacaine (%0/1-%25) 2- Ropivacaine (0/1-0/4) درصد 3- Levobupivacaine 4- Basal Rate 4-8 ml/L bolus volume:2-5 ml Adjuancts: 1- Epinephrine 2- Opioids There are no adjuncts added to local anesthetics that have been demonstrated to provide benefits during CPNB.

“perineural local anesthetic infusion”—involves the percutaneous insertion of a catheter directly adjacent to the peripheral nerve(s) supplying the surgical site.

2- Minimizing supplemental opioids . - فراهم کردن شرایط انفوزیون مداوم توسط خود بیمار موجب اثرات زیر میشود: 1- Improving analgesia. 2- Minimizing supplemental opioids . 3- Decreased basal infusion rate which minimized the risk of limb weakness. 4- Maximizes the infusion duration for ambulatory Patients with a finite local anesthetic infusion pump reservior volume

متغیرهایی که احتمالاً در کیفیت بلوک مؤثر است؟ 1- Surgical procedure 2- Catheter Location. 3- physical Therapy Regimen. 4- specific Local Anesthetic infused.

Until recommendations based on prospectively collected data are published, practitioners should be aware that investigators have reported successful analgesia using the following with long-acting local anesthetics: basal rate of 4 to 8 ml/hr, bolus volume of 2 to 5 ml, and lockout duration of 20 to 60 min.

Potential Risks/ complication نشان دهنده میزان %40-0CPNB-در مطالعه در مورد می باشد Secondray block Failure فاکتورهای مؤثر در شیوع این عوارض عبارتنداز: 1-Experience of practitioners 2-Equipment and technique 3-Patients body Hapitus

اثرات بکارگیری دستگاه اولترا سوند : 1- Decreased vascular pancture 2- Perineuraxis catheter placement 3- Intraneural catheter insertion 4- Decreased neck hematoma Horners syndrome. Perineural شایع ترین عارضه در طول انفوزیون با کانتر مربوط به جابجایی کانتر بطورغیرعمدی می باشد (%30-0)

Other complications occurring during infusion include 1-phrenic nerve block and ipsilateral diaphragm dysfunction during interscalene 2-local anesthetic toxicity (incredibly rare 3-catheter-site bacterial colonization is relatively common, clinically relevant infection is not. 4-additional potential CPNB complications, such as catheter knotting (do not pass the catheter .5 cm past the needle tip), retention (with the Arrow Stimucath),41 and shearing (do not withdraw the catheter back into the needle unless the design.

CONCLUSIONS 1-Future prospective investigation is required to determine the optimal catheter design(s), insertion technique(s), insertion approach(es), infusate(s), delivery regimen, infusion duration, and true incidence of complications. 2-Only by prospectively comparing various approaches will their relative benefits and drawbacks be truly revealed and the science of perineural infusion advanced.