Continuous peripheral nerve blocks (CPNBs) provide a number of advantages in the perioperative period. These techniques provide the flexibility to prolong intraoperative anesthesia while avoiding the risks and side effects of general anesthesia. Following surgery, CPNBs offer extended postoperative analgesia. When compared to parenteral opioid analgesia, CPNBs are associated with superior analgesia, reduced opioid consumption, and decreased opioid-related side effects such as postoperative nausea and vomiting, sedation, and respiratory depression.1-11 Analgesia of similar quality to epidural anesthesia is the result; however, less hypotension, urinary retention, pruritus, and mobility restrictions occur with CPNBs.7,12,13,14 There is also evidence supporting the beneficial effect of CPNBs on postoperative sleep patterns and cognitive function15,16 as well as early rehabilitation.7,8 Concurrent sympathectomy is ideal following microvascular, reimplantation, and free-flap surgery,17,18 as well as for treatment of accidental intra-arterial drug injection.19,20,21 Extended analgesia can also be provided for patients with chronic pain22 and those requiring palliation of terminal illness.23 Finally, preoperative use can reduce phantom limb sensation in patients undergoing amputation.24
Despite these benefits, CPNBs have historically been relatively underused. This early lack of popularity was multifactorial; however, inadequate CPNB equipment likely contributed. The development of CPNB needles, catheters, and nerve localization technology has been essential for the safe use and advancement of these regional anesthesia techniques. This chapter summarizes the equipment required for continuous plexus anesthesia and will review the chronology of the development of modern-day CPNB equipment.
A perineural catheter can be placed in a block room just as the preceding patient’s procedure is finishing. This enhances operating room efficiency and flow. A block room allows the supplies and monitors discussed next to be stocked and stored in one location. The block room should be a clean, semi-sterile room in close proximity to the operating room suite.
Table 13–1 outlines block cart supplies necessary for the performance of CPNBs. Supplies are sterile where applicable.
Table 13–1.Block cart supplies necessary for continuous peripheral nerve blocks. |Favorite Table|Download (.pdf) Table 13–1. Block cart supplies necessary for continuous peripheral nerve blocks.
Sterile gloves ± gown for anesthesiologist
Disinfecting solution (2% chlorhexidine gluconate with 70% isopropyl alcohol)
Needles for subcutaneous local anesthetic infiltration (ie, 25-gauge 1½ inch)
Syringes for subcutaneous local anesthetic infiltration (ie, 3 mL) 2 × 2 in. gauze
Selection of block needles and catheter sets of appropriate diameter and length
Nerve stimulator and electrodes
Selection of ultrasound probes of appropriate frequency, shape, and size
Sterile ultrasound probe covers
Sterile gel for ultrasound imaging
Dextrose 5% in water
Local anesthetics and adjuvants (see below)