Best practice & research. Clinical anaesthesiology
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Early and efficient rehabilitation is necessary for improving outcome after shoulder surgery. Pain, which is severe to very severe in this condition, is the major factor which compromises early physical therapy. Interscalene block is a well recognized and efficient technique for controlling pain after major open shoulder surgery. ⋯ However, the application of a continuous infusion of local anaesthetics through an interscalene catheter is actually the best technique available to achieve pain relief at rest and on movement after this type of surgery. This chapter emphasizes the advantages of the modified lateral approach, the use of patient-controlled interscalene analgesia and the traps and tricks of the interscalene block. Thus, this chapter demonstrates why interscalene anaesthesia and analgesia are the most appropriate techniques for shoulder surgery.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewOutcome after regional anaesthesia in the ambulatory setting--is it really worth it?
Regional anaesthesia provides a continuum of perioperative care that includes perioperative pain management, decreased opioid requirements and decreased post-operative nausea and vomiting. In addition to these benefits, a wide variety of perioperative outcomes can be enhanced by utilizing regional anaesthesia in the ambulatory setting. ⋯ In addition, regional anaesthesia can facilitate early recovery with excellent post-operative analgesia and few side-effects, which may decrease overall operative costs. This chapter identifies important perioperative outcomes that may be positively influenced by the use of regional anaesthesia in the ambulatory setting.
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Incisional and intra-articular local anaesthetic techniques are simple, safe and inexpensive analgesic methods for the management of post-operative pain following a variety of surgical procedures. These techniques are capable of providing effective analgesia over a limited field and with minimal systemic effects. ⋯ The incisional and intra-articular use of opioids and several non-opioids, either alone or in combination with local anaesthetics, has also been evaluated. This chapter reviews the current status of single dose and infusions of local anaesthetics and adjuvants for incisional and intra-articular analgesic techniques and also looks at future perspectives.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewContinuous interscalene block for ambulatory shoulder surgery.
Management of acute post-operative pain due to shoulder surgery may be successfully and consistently achieved in ambulatory patients by using continuous interscalene block. This chapter outlines the anterior and posterior approaches to the proximal brachial plexus and describes a method of precisely placing a catheter along the brachial plexus by stimulating the plexus through the needle used for placing the catheter as well as through the catheter itself. ⋯ Suggested drugs and dosages for initial boluses, continuous infusions and patient controlled interscalene analgesia are discussed. Sedation for block placement, and special precautions, are outlined.
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The majority of upper extremity surgeries are performed on an ambulatory basis under intravenous regional anaesthesia or brachial plexus blockade. The former technique is easy to perform, has a rapid onset and a high success rate but provides limited post-operative analgesia. Brachial plexus blockade provides excellent intraoperative anaesthesia as well as post-operative analgesia, eliminates the need for post-operative opioids, resulting in a decrease in recovery time, shortened hospital stay, increased patient satisfaction and ultimately a decrease in perioperative costs when compared with general anaesthesia. This chapter reviews upper extremity surgical procedures performed below the shoulder, the anaesthetic options available, and techniques used to optimize post-operative pain control.