Postoperative pain relief using regional anaesthesia

摘要

Fear of severe pain after surgery is one of the main concerns of many patients who undergo surgery. There seems to be some justification for this fear. Several recent publications show that the management of postoperative pain is still suboptimal in many institutions. Undertreated postoperative pain may delay discharge and recovery and result in poor rehabilitation and outcomes. Currently, a variety of opioid and non-opioid-based analgesic techniques are used to treat pain. Opioid analgesics, regardless of the route of administration, are associated with a high incidence of adverse effects.In recent years, there has been a great increase in the use of regional anaesthesia techniques for surgery and postoperative pain management. Catheter techniques are increasingly used in in-patients and ambulatory surgery patients to achieve prolonged pain relief lasting several days. The techniques available for postoperative analgesia include neuraxial (central) blocks, peripheral nerve blocks, wound infiltration techniques, intraperitoneal, intra-articular, and intrabursal techniques. There is overwhelming evidence that epidural technique provides superior analgesic efficacy; however, its effects on reducing morbidity and mortality are controversial. Perineural catheter techniques provide better analgesia and fewer side effects when compared with opioid analgesia and are a good alternative to the more invasive epidural technique, particularly for major orthopaedic extremity surgery. There is good evidence that a simple technique of wound catheter infusion of local anaesthetic provides effective analgesia after a variety of surgical procedures with reduced side effects and high patient satisfaction. With the availability of portable pumps, the technique can be used on ambulatory basis.