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Continuous peripheral nerve blocks (CPNBs) provide many advantages in the perioperative period.1 These techniques provide the flexibility to prolong intraoperative anesthesia while avoiding the risks and side effects of general anesthesia. After surgery, CPNBs offer extended postoperative analgesia. When compared with 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.2–12 Analgesia results are of a quality similar to epidural anesthesia results; however, CPNBs are associated with less hypotension, urinary retention, pruritus, and mobility restrictions than epidural analgesia.8,13–15 There is also evidence supporting the beneficial effect of CPNBs on postoperative sleep patterns and cognitive function16,17 as well as early rehabilitation.8,9 Concurrent sympathectomy is ideal after microvascular surgery, reimplantation, and free-flap surgery18,19 as well as for treatment of accidental intraarterial drug injection.20–22 Extended analgesia can also be provided for chronic pain patients23 and those requiring palliation of terminal illness.24 Despite these benefits, CPNBs have historically been relatively underused techniques. These reasons for the underutilization were multifactorial; however, inadequate CPNB equipment likely contributed. Until recently, there had been few commercially available equipment items dedicated for CPNBs. A number of relatively new advances in the area of CPNB needles and catheters have been essential for the safe use and advancement of these regional anesthesia techniques. This chapter summarizes the chronology of the development of CPNB equipment, outlines currently available equipment, and theorizes about possible future directions.

The earliest report of CPNB is attributed to Ansbro25 in 1946 (Figure 48–1). He attached a malleable blunt needle to injection tubing and a syringe. The needle was placed in the supraclavicular area lateral to the pulsations of the subclavian artery and approximately 1 cm cephalad to the midpoint of the clavicle. A cork stopper from an ether can was used to secure the needle in place. Intermittent injections of procaine were given to 27 patients to extend the duration of intraoperative anesthesia for up to 4 hours and 20 minutes.

Fig. 48-1

A: Apparatus consists of a 10-mL Luer-lock syringe and the two-way valve as used in the Hingson-Edwards continuous caudal method. The tubing can be of any desired length (18 inches is sufficient). A malleable needle (Becton-Dickinson & Company) is used, which has been filed to a blunt end to prevent perforation of blood vessels. A cork stopper from an ether can completes the apparatus. B: Apparatus with needle through the cork, ...

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