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Chapter 12. Equipment for Continuous Peripheral Nerve Blocks

The correct dosage for Intralipid 20% is:

A. 1.0 mL/kg (lean body mass) bolus over 1 minute and every 3–5 minutes up to 2 mL/kg, 0.5 mL/kg/min infusion, maximum total 8–10 mL/kg for the first 30 minutes

B. 1.5 mL/kg (actual body weight) bolus over 1 minute and every 3–5 minutes up to 3 mL/kg, 0.25 mL/kg/min infusion, maximum total 8–10 mL/kg for the first 30 minutes

C. 1.5 mL/kg (lean body mass) bolus over 1 minute and every 3–5 minutes up to 3 mL/kg, 0.25 mL/kg/min infusion, maximum total 8–10 mL/kg for the first 30 minutes

D. 0.25 mL/kg (actual body weight) bolus over 1 minute and every 3–5 minutes up to 3 mL/kg, 1.5 mL/kg/min infusion, maximum total 8–10 mL/kg for the first 30 minutes

C is correct. The correct dosage for Intralipid 20% is 1.5 mL/kg bolus (lean body mass) over 1 minute and every 3–5 minutes up to 3 mL/kg, 0.25 mL/kg/min infusion. Total maximum 8 mL/kg for the first 30 minutes based on this chapter and 10 mL/kg based on ASRA recommendations.

A is incorrect. It is correct that Intralipid 20% dosing is calculated based on lean body mass, but the infusion rate is wrong.

B is incorrect. The dosage for Intralipid 20% looks right, but it is calculated based on the actual body weight but not the lean body mass recommended by ASRA; therefore it is still incorrect.

D is incorrect. This answer confused the bolus dosage and continuous infusion rate. The American Society of Regional Anesthesia and Pain Medicine recommends an upper limit or maximum dose of 10 mL/kg of the lipid emulsion over the first 30 minutes.

The benefits of continuous peripheral nerve blockade (CPNB) include:

  • a) CPNB provides extended analgesia for acute pain, chronic pain, and palliative care.

  • b) Sympathectomy associated with CPNB provides benefits in addition to superior analgesia in microvascular, reimplantation, and free-flap surgery.

  • c) CPNB is associated with less respiratory depression, lower opioid requirements, and early rehabilitation.

  • d) CPNB is associated with better sleep pattern and less cognitive dysfunction postoperatively.

A. C

B. C, D

C. A, C

D. A, B, C, D

D is correct. Answer D includes benefits a, b, c, and d. CPNB has multiple advantages as compared to single-injection blockade as well as opioids. All four options below are among the many benefits of CPNB:

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