Assessing the Impact of a Regional Anesthesia Workshop on Anesthesiology Residents’ Perceived Comfort in Performing Peripheral Nerve Blocks

Regional anesthesia has been considered a great tool for maximizing post-operative pain control while minimizing opioid consumption. Post-operative rebound pain, characterized by hyperalgesia after the peripheral nerve block, can however diminish or negate the overall benefit of this modality due to a counter-productive increase in opioid consumption once the block wears off. We reviewed published literature describing pathophysiology and occurrence of rebound pain after peripheral nerve blocks in patients undergoing orthopedic procedures. A search of relevant keywords was performed using PubMed, EMBASE, and Web of Science. Twenty-eight articles (n = 28) were included in our review. Perioperative considerations for peripheral nerve blocks and other alternatives used for postoperative pain management in patients undergoing orthopedic surgeries were discussed. Multimodal strategies including preemptive analgesia before the block wears off, intra-articular or intravenous anti-inflammatory medications, and use of adjuvants in nerve block solutions may reduce the burden of rebound pain. Additionally, patient education regarding the possibility of rebound pain is paramount to ensure appropriate use of prescribed pre-emptive analgesics and establish appropriate expectations of minimized opioid requirements. Understanding the impact of rebound pain and strategies to prevent it is integral to effective utilization of regional anesthesia to reduce negative consequences associated with long-term opioid consumption.

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Local anaesthetic dosage of peripheral nerve blocks in children: analysis of 40 121 blocks from the Pediatric Regional Anesthesia Network database

British Journal of Anaesthesia ◽

10.1016/j.bja.2017.10.019 ◽

2018 ◽

Vol 120 (2) ◽

pp. 317-322 ◽

Cited By ~ 4

Author(s):

S. Suresh ◽

G.S. De Oliveira

Keyword(s):

Peripheral Nerve ◽

Regional Anesthesia ◽

Local Anaesthetic ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Network Database

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The Controversy of Regional Anesthesia, Continuous Peripheral Nerve Blocks, Analgesia, and Acute Compartment Syndrome

Techniques in Orthopaedics ◽

10.1097/bto.0000000000000260 ◽

2017 ◽

Vol 32 (4) ◽

pp. 243-247 ◽

Cited By ~ 5

Author(s):

Olga C. Nin ◽

Matthew R. Patrick ◽

André P. Boezaart

Keyword(s):

Peripheral Nerve ◽

Compartment Syndrome ◽

Regional Anesthesia ◽

Acute Compartment Syndrome ◽

Nerve Blocks ◽

Peripheral Nerve Blocks

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Ultrasound Guidance for Deep Peripheral Nerve Blocks: A Brief Review

Anesthesiology Research and Practice ◽

10.1155/2011/262070 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Anupama Wadhwa ◽

Sunitha Kanchi Kandadai ◽

Sujittra Tongpresert ◽

Detlef Obal ◽

Ralf Erich Gebhard

Keyword(s):

Peripheral Nerve ◽

Regional Anesthesia ◽

Nerve Stimulation ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Sense Of Security ◽

False Sense ◽

Anesthesia Technique ◽

Additional Value

Nerve stimulation and ultrasound have been introduced to the practice of regional anesthesia mostly in the last two decades. Ultrasound did not gain as much popularity as the nerve stimulation until a decade ago because of the simplicity, accuracy and portability of the nerve stimulator. Ultrasound is now available in most academic centers practicing regional anesthesia and is a popular tool amongst trainees for performance of nerve blocks. This review article specifically discusses the role of ultrasonography for deeply situated nerves or plexuses such as the infraclavicular block for the upper extremity and lumbar plexus and sciatic nerve blocks for the lower extremity. Transitioning from nerve stimulation to ultrasound-guided blocks alone or in combination is beneficial in certain scenarios. However, not every patient undergoing regional anesthesia technique benefits from the use of ultrasound, especially when circumstances resulting in difficult visualization such as deep nerve blocks and/or block performed by inexperienced ultrasonographers. The use of ultrasound does not replace experience and knowledge of relevant anatomy, especially for visualization of deep structures. In certain scenarios, ultrasound may not offer additional value and substantial amount of time may be spent trying to find relevant structures or even provide a false sense of security, especially to an inexperienced operator. We look at available literature on the role of ultrasound for the performance of deep peripheral nerve blocks and its benefits.

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Hadzic’s Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia (New York School of Regional Anesthesia) (2nd edition)

Anaesthesia ◽

10.1111/j.1365-2044.2012.07316.x ◽

2012 ◽

Vol 67 (11) ◽

pp. 1301-1302

Author(s):

P. Dhillon ◽

J. Lermitte

Keyword(s):

New York ◽

Peripheral Nerve ◽

Regional Anesthesia ◽

New York School ◽

Ultrasound Guided ◽

Nerve Blocks ◽

Peripheral Nerve Blocks

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Continuous Versus Single-Injection Peripheral Nerve Blocks: A Prospective Cohort Study Comparing Procedural Time and Estimated Personnel Cost

The Open Anesthesiology Journal ◽

10.2174/1874321801509010001 ◽

2015 ◽

Vol 9 (1) ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Brendan Carvalho ◽

Romy D. Yun ◽

Edward R. Mariano

Keyword(s):

Peripheral Nerve ◽

Regional Anesthesia ◽

Nerve Block ◽

Single Injection ◽

Clinical Care ◽

Personnel Cost ◽

Additional Time ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Physician Time

Background and Objectives: Continuous peripheral nerve blocks (CPNB) provide many additional benefits compared to single-injection peripheral nerve blocks (SPNB). However, the time and costs associated with CPNB provision have not been previously considered. The objective of this study was to compare the time required and estimated personnel costs associated with CPNB and SPNB. Methods: This IRB-exempt observational study involved provision of preoperative regional anesthesia procedures in a “block room” model by a dedicated team during routine clinical care. The primary outcome, the time to perform ultrasound-guided popliteal-sciatic blocks, was recorded prospectively. This time measurement was broken down into individual tasks: time to place monitors, prepare the equipment, scan and identify the target, perform the block, and clean up post-procedure. For peripheral nerve block catheters, time to insert, locate, and secure the catheter was also recorded. Cost estimates for physician time were determined using published national mean hourly wages. Results: Time measurements were recorded for 24 nerve block procedures (12 CPNB and 12 SPNB). The median (IQR; range) total time (seconds) taken to perform blocks was 1132 (1083-1290; 1060-1623) for CPNB versus 505 (409-589; 368-635) for SPNB (Table 1; p<0.001). The median (IQR) cost attributed to physician time during block performance was $35.20 ($33.66-$40.11) and $15.69 ($12.73-$18.32) for CPNB and SPNB, respectively. Conclusion: CPNB requires approximately 10 more minutes per procedure to perform when compared to SPNB. This additional time should be considered along with potential patient benefits and available resources when developing a regional anesthesia and acute pain medicine service.

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