%0 Journal Article
%T The Role of Continuous Peripheral Nerve Blocks
%A Jos¨¦ Aguirre
%A Alicia Del Moral
%A Irina Cobo
%A Alain Borgeat
%A Stephan Blumenthal
%J Anesthesiology Research and Practice
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/560879
%X A continuous peripheral nerve block (cPNB) is provided in the hospital and ambulatory setting. The most common use of CPNBs is in the peri- and postoperative period but different indications have been described like the treatment of chronic pain such as cancer-induced pain, complex regional pain syndrome or phantom limb pain. The documented benefits strongly depend on the analgesia quality and include decreasing baseline/dynamic pain, reducing additional analgesic requirements, decrease of postoperative joint inflammation and inflammatory markers, sleep disturbances and opioid-related side effects, increase of patient satisfaction and ambulation/functioning improvement, an accelerated resumption of passive joint range-of-motion, reducing time until discharge readiness, decrease in blood loss/blood transfusions, potential reduction of the incidence of postsurgical chronic pain and reduction of costs. Evidence deriving from randomized controlled trials suggests that in some situations there are also prolonged benefits of regional anesthesia after catheter removal in addition to the immediate postoperative effects. Unfortunately, there are only few data demonstrating benefits after catheter removal and the evidence of medium- or long-term improvements in health-related quality of life measures is still lacking. This review will give an overview of the advantages and adverse effects of cPNBs. 1. Background Since its first description in 1946, cPNB has evolved from a case report of a needle inserted through a cork taped to a patient¡¯s chest to a wide-spread and validated analgesic technique in the postoperative setting [1]. The earliest reports of cPNB focused on prolonging intraoperative surgical anesthesia and the treatment of intractable hiccups [1¨C3]. The indication for cPNB has evolved since then, and many indications have been described in the literature: treatment of vasospasm induced by Raynaud disease [4]; induction of sympathectomy and vasodilation for improvement of blood flow after vascular surgery/trauma [5, 6], replantation or limb salvage [7, 8]; treatment of peripheral embolism [9, 10]; analgesia in the setting of trauma [11]; treatment of chronic pain syndrome such as trigeminal neuralgia [12], complex regional pain syndrome [13], terminal cancer pain, [14], and phantom limb pain [15, 16]. Independently of these indications, the majority of publications dealing with cPNB focus on postsurgical pain treatment, where evidence supports the concept that regional anesthesia and analgesia offers superior pain relief to systemic opioid analgesia
%U http://www.hindawi.com/journals/arp/2012/560879/