Hadzic's Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia, 2e > Section 1. Foundations of Peripheral Nerve Blocks > Chapter 7. Continuous Peripheral Nerve Blocks in Outpatients Brian M. Ilfeld, Elizabeth M. Renehan, F. Kayser Enneking

Introduction

"More than 40% of ambulatory patients experience moderate to severe postoperative pain at home following orthopedic procedures.¹ Up to 16 hours of analgesia may be provided by single-injection peripheral nerve blocks with long-acting local anesthetics. However, following block resolution, ambulatory patients must usually rely on oral opioids to control pain. Unfortunately, opioids are associated with undesirable side effects, such as pruritus, nausea and vomiting, sedation, and constipation. To improve postoperative analgesia following ambulatory surgery, there has been an increasing interest in providing "perineural local anesthetic infusions," also called, "continuous peripheral nerve blocks," to outpatients. This technique involves the percutaneous insertion of a catheter directly adjacent to the peripheral nerve(s) supplying the surgical site. Local anesthetic is then infused via the catheter providing potent, site-specific analgesia. Outpatients may theoretically experience the same level of analgesia previously afforded only to those remaining hospitalized by combining the perineural catheter with a portable infusion pump...."