Page 11
P A I N
C O N T R O L
reported pain scores for 24 hours. Total hip arthroplasties are migrating to the outpatient setting, thanks in part to regional anesthesia. Patients receiving multiple regional anesthesia techniques, including lumbar plexus catheter blocks and single-injection sciatic blocks, are ready for discharge within 23 hours after minimally invasive hip procedures.
Femoral nerve blocks, lumbar plexus blocks and intra-articular injections are commonly used to provide analgesia after outpatient knee arthroscopy involving ligament reconstruction, although the preferred technique remains a matter of debate. As the primary anesthetic agent,
lumbar plexus blocks with or without sciatic nerve blocks provide better short-term benefits for outpatient knee patients compared with general anesthesia, including lower post-op pain scores, shorter times to discharge and higher satisfaction scores.
Patients who receive single-injection blocks placed at the ankle before foot surgery have significantly longer times to the first perceptions of pain, but the benefits typically last just 1 day after surgery. However, a perineural catheter placed in the popliteal space (back of the knee) can extend the initial single-injection pain control for up to 3 days after foot and ankle surgery.
— Daniel Cook
-----------------------
dence indicates prolonged local anesthetic exposure may increase nerve injury risk in this population. Patients with histories of allergies to particular anesthetics or classes of anesthetics aren't suitable block candidates. Regional can drop blood pressure, cause seizures and even cardiac arrest, as well as a host of less serious reactions. It's also contraindicated for patients with pronounced aortic stenosis.
When considering regional for pediatric patients, there must be a clear indication for performing blocks, because adolescent anatomy is more difficult to maneuver around safely. Anesthetic doses must be reduced for geriatrics and great care must be taken to maintain cardiopulmonary systems
