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R E G I O N A L
A N E S T H E S I A
But the ability of patients and their caregivers to be educated
about post-op care is absolutely critical. And because of their
intrinsic risks, you should reserve continuous blocks for
• surgical procedures that you expect to result in pain not easily
controlled by less-invasive analgesic techniques, such as oral analgesics and cooling or heating pads; and
• patients who'll benefit from CPNBs or who are intolerant to
alternative analgesics (for example, they experience opioid-induced
nausea).
There are few contraindications to in-facility CPNBs, such as
infection at the catheter insertion site. But because patients are
rarely directly monitored outside of the hospital — and not all
patients desire or are capable of accepting the additional responsibility of caring for the catheter and pump system — patient
selection criteria must be more stringent for ambulatory CPNBs.
To avoid local anesthetic toxicity, exclude patients with renal or
hepatic insufficiency from outpatient perineural infusion. For infusions possibly affecting the phrenic nerve and weakening the ipsilateral diaphragm (interscalene and paravertebral catheters, for example), use caution among patients with heart or lung disease and in
obese patients who may not be able to compensate for mild hypoxia
or hypercarbia.
Limited evidence indicates that the risk of nerve injury from
prolonged local anesthetic exposure may be increased in
patients with diabetes or preexisting neuropathy — something
to keep in mind, though not a deciding factor, when selecting
CPNB candidates.
The case for CPNBs
Benefits may include decreased supplemental opioid require9 2
O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U N E 2013
