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Part 4. Managing Anesthesia Care
Section D. Regional Anesthesia
Chapter 48. Peripheral Nerve Blocks
Denise J. Wedel, MD, and Terese T. Horlocker, MD
1. In performing peripheral nerve blocks, elicitation of a paresthesia is equivalent to electrical stimulation. Success rate and onset time are improved if multiple stimulations are performed, particularly with axillary blockade.
2. The use of ultrasonography for peripheral blockade improves the quality of blockade and decreases onset time. However, overall success rate is not substantially altered.
3. The role of stimulating versus nonstimulating catheters for continuous peripheral nerve blocks to improve success rate is an active area of research.
4. Diaphragmatic paresis in 100% of patients undergoing interscalene block, even with dilute local anesthetic solutions. Phrenic nerve paresis has also been reported following both supraclavicular and infraclavicular approaches, but with less frequency.
5. Continuous lower-extremity peripheral blockade consistently provides superior analgesia compared to conventional systemic opioid therapy. In addition, continuous femoral nerve block improves outcome and rehabilitation following total knee replacement and is superior to epidural analgesia.
6. Because the sciatic nerve divides into its tibial and peroneal components 710 cm above the knee, popliteal fossa block should be performed at this level.
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