Continuous Peripheral Nerve Blocks CONTINUOUS PERIPHERAL NERVE BLOCKS
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.
ﺯیﺮ ﻓﺮﺍﻫﻢ کﺮﺩﻥ ﺷﺮﺍیﻂ ﺍﻧﻔﻮﺯیﻮﻥ ﻣﺪﺍﻭﻡ ﺗﻮﺳﻂ ﺧﻮﺩ ﺑیﻤﺎﺭ ﻣﻮﺟﺐ ﺍﺛﺮﺍﺕ : 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 ﺍﺣﺘﻤﺎﻻ 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 longacting 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 0 -40% ﻧﺸﺎﻥ ﺩﻫﻨﺪﻩ ﻣیﺰﺍﻥ CPNB 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
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.
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