Continuous peripheral nerve blocks in clinical practice.

PURPOSE OF REVIEW: The present review highlights new insights into indications and guidance during procedures for continuous peripheral nerve blocks.

RECENT FINDINGS: Continuous peripheral nerve blocks consistently provide better analgesia than traditional systemic opioid-based analgesia. The literature shows that continuous peripheral nerve blocks prolong site-specific local anesthetic delivery in the outpatient setting, allow optimal analgesia, have minimal side effects, and avoid premature regression of an analgesic block. Furthermore, an improvement in patients' health-related quality of life or outcome benefits has been demonstrated. It appears that continuous peripheral nerve blocks are generally superior to intraarticular local anesthetic infusion for immediate postoperative pain, but new data demonstrate that, apart from a multimodal analgesia regimen, periarticular and intraarticular application of local anesthetics can improve early postoperative analgesia and mobilization. Finally, it seems that, only for interscalene and popliteal sciatic nerve blocks, the use of stimulating catheters slightly decreases visual analog scale scores for postoperative pain and intravenous opioid rescue analgesia. Ultrasound guidance offers the potential advantage to confirm catheter tip location.

SUMMARY: Continuous peripheral nerve blocks are essential in the perioperative anesthetic management of in-hospital or ambulatory patients. Ultrasound guidance and stimulating catheters can help anesthetists during the procedure.