Neel Desai1,2, Kariem El-Boghdadly1,2, Eric Albrecht3. 1. Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust. 2. King's College London, London, United Kingdom. 3. Department of Anaesthesia, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.
Abstract
PURPOSE OF REVIEW: Despite peripheral nerve blockade offering analgesic benefits and improving patient satisfaction, it has not been well adopted in ambulatory anesthesia. In this review, we aim to summarize the evidence underlying peripheral nerve blockade, local anesthetic adjuncts, continuous peripheral nerve blockade and novel analgesic modalities, with the objective to provide recommendations on postoperative analgesia optimization after peripheral nerve blockade in an ambulatory setting. RECENT FINDINGS: Barriers to the widespread use of peripheral nerve blockade in ambulatory anesthesia could include lack of education and training, and increased anesthetic induction time. Strategies that have demonstrated promise to increase duration of action and attenuate rebound pain phenomenon after peripheral nerve blockade include multimodal analgesia, local anesthetic adjuncts and continuous infusion of local anesthetic. Dexamethasone has been demonstrated to be the most effective local anesthetic adjunct. Continuous peripheral nerve blockade is a reasonable alternative but at the expense of additional costs and logistical reorganization. There is currently insufficient data to promote the ambulatory use of liposomal bupivacaine, cryoanalgesia and percutaneous peripheral nerve stimulation. SUMMARY: Educational programs and parallel processing may promote peripheral nerve blockade in an ambulatory setting, improving the patient experience in the postoperative period. Intravenous dexamethasone should be considered wherever appropriate as part of a multimodal analgesic strategy to optimize postoperative pain control.
PURPOSE OF REVIEW: Despite peripheral nerve blockade offering analgesic benefits and improving patient satisfaction, it has not been well adopted in ambulatory anesthesia. In this review, we aim to summarize the evidence underlying peripheral nerve blockade, local anesthetic adjuncts, continuous peripheral nerve blockade and novel analgesic modalities, with the objective to provide recommendations on postoperative analgesia optimization after peripheral nerve blockade in an ambulatory setting. RECENT FINDINGS: Barriers to the widespread use of peripheral nerve blockade in ambulatory anesthesia could include lack of education and training, and increased anesthetic induction time. Strategies that have demonstrated promise to increase duration of action and attenuate rebound pain phenomenon after peripheral nerve blockade include multimodal analgesia, local anesthetic adjuncts and continuous infusion of local anesthetic. Dexamethasone has been demonstrated to be the most effective local anesthetic adjunct. Continuous peripheral nerve blockade is a reasonable alternative but at the expense of additional costs and logistical reorganization. There is currently insufficient data to promote the ambulatory use of liposomal bupivacaine, cryoanalgesia and percutaneous peripheral nerve stimulation. SUMMARY: Educational programs and parallel processing may promote peripheral nerve blockade in an ambulatory setting, improving the patient experience in the postoperative period. Intravenous dexamethasone should be considered wherever appropriate as part of a multimodal analgesic strategy to optimize postoperative pain control.