Management of postoperative pain and comparison of duration of analgesia between Intrathecal Buprenorphine and peripheral nerve blockade (femoral & sciatic nerve blocks)

Abstract: The perioperative pain management – instead of the efforts, guidelines and protocols – is underestimated and undertreated. Even in the case of general anaesthesia, the nervous system is overwhelmed by copious quantities of nociceptive stimuli at surgical incision. Stress and pain-modulation processes are triggered which can have significant influence on the outcome. Often the pain-management is discontinued, so a notable part of patients complain about pain in the ward after surgery. Regional anaesthesia conceptually prevents noxious inputs to enter the central nervous system, beyond surgical anaesthesia it is pertinent to achieve excellent analgesia in the immediate postoperative period as well. Based on current literature, this paper provides an overview of the history and role of regional anaesthesia in the multidimensional model of pain. Besides the sensitization caused by nociceptive stimuli – peripheral and central sensitization, descending modulation – there are several biopsychosocial factors involved in pain pathophysiology. Preventing the side effects of general anaesthesia, the ultrasound-guided peripheral nerve blockade is a safe technique with high success rate, rare side effects, achieving long-lasting, excellent analgesia. Continuous perineural catheter placed under ultrasound provides extended pain control. As a part of multimodal analgesia, peripheral nerve blockade prevents central sensitization. After surgery, the pain intensity of patients under peripheral nerve blockade is less, the chronification tendency is decreased, the quality of life and patients’ comfort are improved, and the stress-response is attenuated. The greater part of patients are protected from the undesirable side effects of general anaesthesia. Nowadays, it is an unequivocal evidence that the increasingly used peripheral nerve blockades prior to incision are efficient tools in the prevention of chronic postoperative pain. Ultrasound guidance is suitable not only for surgical anaesthesia, but for postoperative pain management as well, however, besides economic factors, the main goal of this technique is to match the best interest of the patients. Orv Hetil. 2019; 160(15): 573–584.

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Use of Liposomal Bupivacaine in Pediatric Peripheral Nerve Blocks after Traumatic Amputation

Case Reports in Anesthesiology ◽

10.1155/2021/8092204 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Gregory M. Halenda ◽

Stylianos Voulgarelis

Keyword(s):

Peripheral Nerve ◽

Regional Anesthesia ◽

Phantom Limb ◽

Leg Pain ◽

Traumatic Amputation ◽

Opioid Use ◽

Nerve Blocks ◽

Nerve Blockade ◽

Liposomal Bupivacaine ◽

Peripheral Nerve Blockade

Liposomal bupivacaine has been explored for indications in regional anesthesia, but little has been reported about its use in pediatric patients. In March 2021, the FDA approved an indication for liposomal bupivacaine as an infiltrated local anesthetic in children older than the age of six. Despite this recently expanded indication, the literature lacks reports of use for peripheral nerve blockade in children. We describe a case where liposomal bupivacaine was used for femoral and sciatic nerve blocks in a 5-year-old child with traumatic amputation of his lower leg. Pain control was excellent, with no pain or opioid use reported during the first 62 hours. After the regional anesthesia subsided, the patient required in total 4 oral doses of oxycodone 0.1 mg/kg prior to discharge. The patient did not develop chronic pain or phantom limb syndrome. While liposomal bupivacaine is not currently FDA-approved for peripheral nerve blockade in children, this case highlights a potentially effective use of this drug and possible area for further investigation.

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Peripheral Nerve Blockade in the Pediatric Patient

10.1093/med/9780190685157.003.0056 ◽

2018 ◽

Author(s):

Joel Stockman ◽

Lisa Lee

Keyword(s):

Peripheral Nerve ◽

Pediatric Patient ◽

Pain Therapy ◽

Adult Population ◽

Nerve Blocks ◽

Continuous Growth ◽

Nerve Blockade ◽

System P ◽

Peripheral Nerve Blockade ◽

Patient Refusal

Peripheral nerve blockade among the pediatric and adult population has seen continuous growth over the past decade. Improvements in ultrasonography and proven safety with minimal complications further the utilization of upper and lower extremity blockade. Procedures can safely be completed under general anesthesia in the pediatric patient. Catheters can be left in place to prolong blockade, allowing the patient to decrease narcotic pain medication for longer time periods. Contraindications include patient refusal, coagulopathy, and local infection. Continuous peripheral nerve blocks deliver prolonged analgesia and offer an alternative to opioid-based pain therapy for procedures with all projected pain types—mild to severe. Appropriate patient selection is necessary for ensuring safety when sending patients home with a catheter/delivery system.

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Amitriptyline versus Bupivacaine in Rat Sciatic Nerve Blockade

Anesthesiology ◽

10.1097/00000542-200104000-00021 ◽

2001 ◽

Vol 94 (4) ◽

pp. 661-667 ◽

Cited By ~ 62

Author(s):

Peter Gerner ◽

Mustafa Mujtaba ◽

Catherine J. Sinnott ◽

Ging Kuo Wang

Keyword(s):

Sciatic Nerve ◽

Peripheral Nerve ◽

Tricyclic Antidepressant ◽

Gh3 Cells ◽

High Frequency Stimulation ◽

Na Channels ◽

Nerve Blockade ◽

Peripheral Nerve Blockade

Background Amitriptyline, a tricyclic antidepressant, is frequently used orally for the management of chronic pain. To date there is no report of amitriptyline producing peripheral nerve blockade. The authors therefore investigated the local anesthetic properties of amitriptyline in rats and in vitro. Methods Sciatic nerve blockade was performed with 0.2 ml amitriptyline or bupivacaine at selected concentrations, and the motor, proprioceptive, and nociceptive blockade was evaluated. Cultured rat GH3 cells were externally perfused with amitriptyline or bupivacaine, and the drug affinity toward inactivated and resting Na+ channels was assessed under whole-cell voltage clamp conditions. In addition, use-dependent blockade of these drugs at 5 Hz was evaluated. Results Complete sciatic nerve blockade for nociception was obtained with amitriptyline for 217 +/- 19 min (5 mM, n = 8, mean +/- SEM) and for 454 +/- 38 min (10 mM, n = 7) versus bupivacaine for 90 +/- 13 min (15.4 mM, n = 6). The time to full recovery of nociception for amitriptyline was 353 +/- 12 min (5 mM) and 656 +/- 27 min (10 mM) versus 155 +/- 9 min for bupivacaine (15.4 mM). Amitriptyline was approximately 4.7-10.6 times more potent than bupivacaine in binding to the resting channels (50% inhibitory concentration [IC50] of 39.8 +/- 2.7 vs. 189.6 +/- 22.3 microM) at - 150 mV, and to the inactivated Na+ channels (IC50 of 0.9 +/- 0.1 vs. 9.6 +/- 0.9 microM) at -60 mV. High-frequency stimulation at 3 microM caused an additional approximately 14% blockade for bupivacaine, but approximately 50% for amitriptyline. Conclusion Amitriptyline is a more potent blocker of neuronal Na+ channels than bupivacaine in vivo and in vitro. These findings suggest that amitriptyline could extend its clinical usefulness for peripheral nerve blockade.

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Faculty Opinions recommendation of Efficacy of supplemental peripheral nerve blockade for hip fracture surgery: multiple treatment comparison.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717976548.793472205 ◽

2013 ◽

Author(s):

Andreas Hoeft

Keyword(s):

Hip Fracture ◽

Peripheral Nerve ◽

Nerve Blockade ◽

Hip Fracture Surgery ◽

Multiple Treatment ◽

Treatment Comparison ◽

Peripheral Nerve Blockade ◽

Multiple Treatment Comparison ◽

Fracture Surgery

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Faculty Opinions recommendation of Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727020037.793539146 ◽

2017 ◽

Author(s):

Jacques Chelly

Keyword(s):

Postoperative Pain ◽

Peripheral Nerve ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Challenges And Opportunities

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Predictors of hospital admission after rotator cuff repair: the role of peripheral nerve blockade

European Journal of Anaesthesiology ◽

10.1097/00003643-201306001-00423 ◽

2013 ◽

Vol 30 ◽

pp. 135-136

Author(s):

O. Stundner ◽

T. Danninger ◽

R. Rasul ◽

M. Mazumdar ◽

P. Gerner ◽

...

Keyword(s):

Rotator Cuff ◽

Peripheral Nerve ◽

Hospital Admission ◽

Rotator Cuff Repair ◽

Nerve Blockade ◽

Peripheral Nerve Blockade ◽

Cuff Repair

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Comparison of continuous femoral nerve block with and without combined sciatic nerve block after total hip arthroplasty: a prospective randomized study

Orthopedic Reviews ◽

10.4081/or.2017.7063 ◽

2017 ◽

Vol 9 (2) ◽

Cited By ~ 2

Author(s):

Shoji Nishio ◽

Shigeo Fukunishi ◽

Tomokazu Fukui ◽

Yuki Fujihara ◽

Shohei Okahisa ◽

...

Keyword(s):

Postoperative Pain ◽

Sciatic Nerve ◽

Total Hip Arthroplasty ◽

Nerve Block ◽

Hip Arthroplasty ◽

Femoral Nerve Block ◽

Femoral Nerve ◽

Sciatic Nerve Block ◽

Nerve Blockade ◽

Continuous Femoral Nerve Block

In association with the growing interests in pain management, several modalities to control postoperative pain have been proposed and examined for the efficacy in the recent studies. Various modes of peripheral nerve block have been proposed and the effectiveness and safety have been examined for each of those techniques. We have described our clinical experiences, showing that continuous femoral nerve block could provide a satisfactory analgesic effect after total hip arthroplasty (THA) procedure. In this study, we compared the effectiveness and safety of continuous femoral nerve block with and without sciatic nerve blockade on pain control after THA. Forty patients scheduled for THA were included in the study and randomly divided into 2 groups. Postoperative analgesic measure was continuous femoral nerve block alone, while the identical regimen of continuous femoral nerve block was combined with sciatic nerve block. The amount of postoperative pain was evaluated in the immediate postoperative period, 6 hours, and 12 hours after surgery. Moreover, postoperative complications as well as requirement of supplemental analgesics during the initial 12 hours after surgery were reviewed in the patient record. The obtained study results showed that the supplemental sciatic nerve blockade provided no significant effect on arrival at the postoperative recovery room, while the NRS pain score was significantly reduced by the combined application of sciatic nerve blockade at 6 and 12 hours after surgery. In the investigation of postoperative analgesiarelated complications, no major complication was encountered without significant difference in complication rate between the groups.

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