Single shot techniques
Single shot brachial plexus and major peripheral nerve blocks can provide 12 to 24 hours analgesia. To avoid the sudden return of severe pain as the block wears off, start suitable sequential analgesia (see section 8.c.i) before the block fully wears off and ensure that it is taken regularly.
Continuous catheter infusions can extend postoperative analgesia for more complex day surgery e.g. knee ligament reconstruction and arthroscopic shoulder surgery. Regional analgesia can now be self-administered by the patient (Patient-Controlled Regional Analgesia [PCRA]) at home using elastomeric balloon or portable electronic pumps connected to perineural or wound catheters. These devices allow either a continuous infusion of local anaesthetic at a pre-set rate or patient controlled boluses, or a combination of both systems, with safeguards to avoid the risk of local anaesthetic toxicity:
• Adequate patient information is important
• Suitable local anaesthetics include ropivacaine, levobupivacaine, and bupivacaine in low concentration (1-2 mg/ml)
The techniques are still being evaluated in clinical trials and overall experience is limited at the present time.
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