Physiologic Advantages of Peripheral Nerve Blockade Translate to Decreased Length of Stay and Improved Patient Satisfaction
DOI:
https://doi.org/10.17140/RPAOJ-1-103Abstract
Peripheral nerve blockade is an effective modality involved in controlling perioperative pain. When compared with patient controlled analgesia, neuraxial analgesia, and other anesthetic methods such as periarticular infiltration, peripheral nerve blocks yield superior pain control and reduce length of hospitalization. Not only do these techniques help with patient satisfaction and health care costs, they also have physiologic advantages. In murine models, peripheral nerve blockade reduces expression of different inflammatory markers such as IL-1, IL-6, TNFα and cortisol. Such advantages make this an attractive modality for pain control.
References
Prabhakar A, Mancuso K, Paul C, et al. Perioperative anal-gesia outcomes and strategies. Best Pract Res Cl Anesth. 2014; 28;105-115. doi: 10.1016/j.bpa.2014.04.005
Malchow RJ, Black IH. The evolution of pain management in the critically ill trauma patient: emerging concepts from the global war on terrorism. Crit Care Med. 2008; 36(7): 346-357. doi: 10.1097/CCM.0b013e31817e2fc9
Mathiesen O, Wetterslev J, Kontinen VK, et al. Adverse ef-fects of perioperative paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: a topical review. Acta Anaesthesiol Sc and. 2014; 58(10): 1182-1198. doi: 10.1111/ aas.12380
Kaye AD, Ali SI, Urman RD. Perioperative analgesia: ever changing technology and pharmacology. Best Pract Res Cl Anesth. 2014; 28(1): 3-14. doi: 10.1016/j.bpa.2014.03.002
Gritsenko K, Khelemsky Y, Kaye AD, et al. Multimodal ther-apy in perioperative analgesia. Best Pract Res Cl Anesth. 2014; 28(1): 59-79. doi: 10.1016/j.bpa.2014.03.001
Mariano E, Marshall Z, Urman R, et al. Ultrasound and its evolution in perioperative regional anesthesia and alangesia. Best Pract Res Cl Anesth 2014; 28(1): 29-39. doi: 10.1016/j. bpa.2013.11.001
Bingham A, Fu A, Horn JL, Abrahams MS. Continuous pe-ripheral nerve block compared with single-injection peripheral nerve block: a systematic review and meta-analysis of random-ized controlled trials. Reg Anesth Pain Med. 2012; 37(6): 583- 594. doi: 10.1097/AAP.0b013e31826c351b
Aguirre J, DelMoral A, Cobo I, et al. Review article the role of continuous peripheral nerve blocks. Anesth Res Pract. 2012; 10: 1155. doi: 10.1155/2012/560879
Ilfeld B, Morey T, Wang D, Enneking K. Continuous popli-teal sciatic nerve block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesthe-siology. 2002; 97 (4):959-965.
Richman J, Liu S, Courpas G, et al. Does continuous periph-eral nerve block provide superior pain control to opioids? a me-ta-analysis. Anesth Analg. 2006; 102: 248-257. doi: 10.1213/01. ANE.0000181289.09675.7D
Wang JY, Huang J, Chang JY, et al. Morphine modulation of pain processing in medial and lateral pain pathways. Mol Pain. 2009; 5:60 doi: 10.1186/1744-8069-5-60
Edwards ND, Wright EM. Continuous low-dose 3-in-1 nerve blockade for postoperative pain relief after total knee replace-ment. Anesth Analg. 1992; 75(2): 265-267.
Bushnell B, Sakryd G, Noonan T. Hamstring donor-site block: evaluation of pain control after anterior cruciate liga-ment reconstruction. Arthroscopy. 2010; 26(7): 894-900. doi: 10.1016/j.arthro.2009.11.022
Edkin BS, Spindler KP, Flanagan JF. Femoral nerve block as an alternative to parenteral narcotics for pain control after ante-rior cruciate ligament reconstruction. Arthroscopy. 1995; 2: 404- 409. doi: 10.1016/0749-8063(95)90191-4
Santos Gde C, Braga GM, Queiroz FL, Navarro TP, Go-mez RS. Assessment of postoperative pain and hospital dis-charge after inguinaland iliohypogastric nerve block for ingui-nal hernia repair under spinal anesthesia: a prospective study. Rev Assoc Med Bras. 2011; 57: 535-538. doi: 10.1590/S0104- 42302011000500013
Chelly JE, Greger J, Gebhard R, et al. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty. 2001; 16: 436-445. doi: 10.1054/arth.2001.23622
Singelyn FJ, Ferrant T, Malisse MF, Joris D. Effects of in-travenous patient-controlled analgesia with morphine, continu-ous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty. Reg Anesth Pain Med. 2005; 30(5): 452-457. doi: 10.1016/j. rapm.2005.05.008
White P, Issioui T, Skrivanek G, et al. The use of a con-tinuous popliteal sciatic nerve block after surgery involving the foot and ankle: does it improve the quality of recovery? Anesth Analg. 2003;97:1303–1309
Siddiqui Z, Cepeda S, Denman W, et al. Continuous sum-bar plexus block provides improved analgesia with fewer side effects compared with systemic opioids after hip arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2007; 32: 393-398.
Uda R, Horiguchi S, Ito S, et al. Nociceptive effects in-duced by intrathecal administration of prostaglandin D2, E2, or F2 α to conscious mice. Brain Res. 1990; 510(1): 26-32. doi: 10.1016/0006-8993(90)90723-O
Borgeat A, Perschak H, Bird P, Hodler J, Gerber C. Patient controlled interscalene analgesia with ropivacaine 0.2% versus patient controlled intravenous angelegsia after major shoulder surgery. Anesthesiology. 2000; 92(1): 102-108.
Borgeat A, Schappi B, Biasca N, et al. Patient-controlled analgesia after major shoulder surgery. Anesthesiology. 1997; 87(6): 1343-1347.
Borgeat A, Tewes E, Biasca N, Gerber C. Patient controlled interscalane analgesia with Ropivicaine After Major Shoulder Surgery: PCIA vs PCA. Brit J Anaesth. 1998; 81: 603-605. doi: 10.1093/bja/81.4.603
Klein S, Grant S, Greengrass R, et al. Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump. Anesth Analg. 2000; 91: 1473-1478. doi: 10.1097/00000539-200012000-00033
Lehtipalo S, Koskinen D, Johansson G, Kolmodin J, Biber B. Continuous interscalene brachial plexus block for postoperative analgesia following shoulder surgery. Acta Anaesthesiol Sc and. 1999; 43: 258-264. doi: 10.1034/j.1399-6576.1999.430304.x
Hirst G, Lang S, Dust W, Cassidy D, Yip R. Single injection versus continuous infusion for total knee arthroplasy. Region Anesth. 1996; 21: 292-297.
Cuignet O, Pirson J, Boughrouph J, Duville D. The ef-ficacy of continuous fascia iliaca compartment block for pain management in burn patients undergoing skin grafting proce-dures. Anesth Analg. 2004; 98: 1077-1081. doi: 10.1213/01. ANE.0000105863.04140.AE
Fozzard HA, Lee PJ, Lipkind GM. Mechanism of local anes-thetic drug action on voltage-gated sodium channels. Curr Pharm Des. 2005; 11(21): 2671-2686. doi: 10.2174/1381612054546833
Singelyn FJ, Deyaert M, Joris D, Pendevillet J, Gouverneur JM. Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg. 1998; 87: 88-92. doi: 10.1213/00000539-199807000-00019
Woods G, O’Connor D, Calder C. Continuous femoral nerve block versus intra-articular injection for pain control after ante-rior cruciate ligament reconstruction. Am J Sport Med. 2006; 34: 1328-1333. doi: 10.1177/0363546505286145
Cunha FQ, Poole S, Lorenzetti BB, Ferreira SH. The pivotal role of tumour necrosis factor alpha in the development of in-flammatory hyperalgesia. Br J Pharmacol. 1992;107: 660-664. doi: 10.1111/j.1476-5381.1992.tb14503.x
Sweitzer SM, Colburn RW, Rutkowski M, DeLeo JA. Acute peripheral inflammation induces moderate glial activation and spinal IL-1β expression that correlates with pain behavior in the rat. Brain Res. 1999; 829: 209-221. doi: 10.1016/S0006- 8993(99)01326-8
Samad TA, Moore KA, Sapirstein A, et al. Interleukin-1β-mediated induction of cox-2 in the CNS contributes to inflam-matory pain hypersensitivity. Nature. 2001; 410: 471-475. doi: 10.1038/35068566
Cunha TM, Verri WA Jr, Silva JS, Poole S, Cunha FQ, Fer-reira SH. A cascade of cytokines mediates mechanical inflam-matory hypernociception in mice. Proc Natl Acad Sci U S A. 2005; 102(5): 1755-1760. doi: 10.1073/pnas.0409225102
Jin X, Gereau RW 4th. Acute p38-mediated modulation of te-trodotoxin resistant sodium channels in mouse sensory neurons by tumor necrosis factor α. J Neurosci. 2006; 26(1): 246-255. doi: 10.1523/JNEUROSCI.3858-05.2006
Bagry H, Fontaine J, Asenjo J, Bracco D, Carli F. Effect of a continuous peripheral nerve block on the inflammatory response in knee arthroplasty. Reg Anesth Pain Med. 2008; 33: 17-23. doi: 10.1016/j.rapm.2007.06.398
Andres BM, Taub DD, Gurkan I, Wenz JF. Postoperative fever after total knee arthroplasty: the role of cytokines. Clin Orthop Relat Res. 2003; (415): 221-231. doi: 10.1097/01. blo.0000093914.26658.55
Baba H, Kohno T, Moore KA, Woolf CJ. Direct activation of rat spinal dorsal horn neurons by prostaglandin E2. J Neurosci. 2001; 21(5): 1750-1756.
Buvanendran A, Kroin JS, Berger RA, et al. Upregulation of prostaglandin E2 and interleukins in the central nervous system and peripheral tissue during and after surgery in humans. Anes-thesiology. 2006; 104: 403-410.
Sarkar S, Hobson AR, Hughes A, et al. The Prostaglandin E2 Receptor-1 (EP-1) Mediates Acid-Induced Visceral Pain Hyper-sensitivity in Humans. Gastroenterology. 2003; 124(1): 18-25. doi: 10.1053/gast.2003.50022
Rummel C, Sachot C, Poole S, Luheshi GN. Circulating in-terleukin-6 induces fever through a STAT3-linked activation of COX-2 in the brain. Am J Physiol Regul Integr Comp Physiol.. 2006; 291(5): 1316-1326. doi: 10.1152/ajpregu.00301.2006
Urade Y, Hayaishi O. Prostaglandin D2 and sleep/wake reg-ulation. Sleep Med Rev. 2011; 15(6): 411-418. doi: 10.1016/j. smrv.2011.08.003
Munford RS, Pugin J. Normal responses to injury prevent systemic inflammation and can be immunosuppressive. Am J Respir Crit Care Med. 2001; 163: 316-321. doi: 10.1164/ajrc-cm.163.2.2007102
Weissman C. The metabolic response to stress: an overview and update. Anesthesiology. 1990; 73: 308-327.
Altar CA, DiStefano PS. Neurotrophin trafficking by an-terograde transport. Trends Neurosci. 1998; 21: 433-437. doi: 10.1016/S0166-2236(98)01273-9
Curtis R, Tonra JR, Stark JL, et al. Neuronal injury increases retrograde axonal transport of the neurotrophins to spinal sen-sory neurons and motor neurons via multiplereceptormecha-nisms. Mol Cell Neurosci. 1998; 12: 105-118. doi: 10.1006/ mcne.1998.0704
Gentili ME, Mazoit JX, Samii K K, Fletcher D. The effect of a sciatic nerve block on the development of inflammation in carrageenan injected rats. Anesth Analg. 1999; 89(4): 979-984. doi: 10.1213/00000539-199910000-00029
Deruddre S, Combettes E, Estebe JP, et al. Effects of a bu-pivacaine nerve block on the axonal transport of tumor necrosis factor-α (TNFα) in a rat model of carrageenan-induced inflam-mation. Brain Behav Immun. 2010; 24: 652-659. doi: 10.1016/j. bbi.2010.01.013
Beloeil H, Ababneh Z, Chung R, Zurakowski D, Mulkern RV, Berde CB. Effects of bupivacaine and tetrodotoxin on car-rageenan-induced hind pawinflammation in rats (part 1): hyper-algesia, edema, and systemic cytokines. Anesthesiology. 2006; 105(1): 128-138.
Beloeil H, Gentili M, Benhamou D, Mazoit JX. The effect of a peripheralblock on inflammation-induced prostaglandin E2 and cyclooxygenase expression in rats. Anesth Analg. 2009; 109: 943-950. doi: 10.1213/ane.0b013e3181aff25e
Guay J, Bateman K, Gordon R, Mancini J, Riendeau D. Car-rageenan-induced paw edema in rat elicits a predominant prosta-glandin E2 (PGE2) response in the central nervous system asso-ciated with the induction of microsomal PGE2 synthase-1. J Biol Chem. 2004; 279: 24866-24872. doi: 10.1074/jbc.M403106200
Ichitani Y, Shi T, Haeggstrom JZ, Samuelsson B, Hökfelt T. Increased levels of cyclooxygenase-2 mRNA in the rat spi-nal cord after peripheral inflammation: an in situ hybridization study. Neuroreport. 1997; 8(13): 2949-2952.
Pham-Marcou TA, Beloeil H, Sun X, et al. Antinociceptive effect of resveratrol in carrageenan-evoked hyperalgesia in rats: prolonged effect related to COX-2 expression impairment. Pain. 2008; 140: 274-283. doi: 10.1016/j.pain.2008.08.010
Desborough J. The stress response to trauma and surgery. Br J Anaesth. 2000; 85: 109-117. doi: 10.1093/bja/85.1.109
da Fonseca Pacheco D, Klein A, de Castro Perez A, da Fon-seca Pacheco CM, de Francischi JN, Duarte ID. The mu-opioid receptor agonist morphine, but not agonists at delta- or kappa-opioid receptors, induces peripheral antinociception mediated by cannabinoid receptors. Br J Pharmacol. 2008; 154: 1443- 1449. doi: 10.1038/bjp.2008.175
Jones AK, Friston KJ, Qi LY, et al. Sites of action of morphine in the brain. Lancet. 1991; 338(8770): 825. doi: 10.1016/0140- 6736(91)90717-4
McDonald RK, Evans FT, Weise VK, Patrick RW. Effect of morphine and nalorphine on plasma hydrocortisone levels in man. J Pharmacol Exp Ther. 1959; 125(3): 241-247.
Bent JM, Paterson JL, Mashiter K, Hall GM. Effects of high-dose fentanyl anaesthesia on the established metabolic and en-docrine response to surgery. Anaesthesia. 1984; 39(1): 19-23. doi: 10.1111/j.1365-2044.1984.tb09447.x
Desborough J, Hall G. Modification of the hormonal and metabolic response to surgery by narcotics and general an-eaesthesia. Clin Anaesthesiol. 1989; 3: 317-334. doi: 10.1016/ S0950-3501(89)80003-0
Klingstedt C, Giesecke K, Hamberger B, Järnberg PO. High-and low-dose fentanyl anasethesia, circulatory and catechol-amine responses during cholecystectomy. Br J Anaesth. 1987; 59(2): 184-188. doi: 10.1093/bja/59.2.184
Celic-Spuzic E. Effect of anesthesia on the changes in the hormones levels during and after transvesical prosta-tectomy. Med Arh. 2011; 65(6): 348-353. doi: 10.5455/me-darh.2011.65.348-353
Wolf AR. Effects of regional analgesia on stress respons-es to pediatric surgery. Pediatr Anesth. 2012; 22: 19-24. doi: 10.1111/j.1460-9592.2011.03714.x
Brewslow MJ, Parker SD, Frank SM, et al. Determinants of catecholamine and cortisol responses to lower extremity revas-cularization. Anesthesiology. 1993; 79: 1202-1209.
Pflug AE, Halter JB. Effect of spinal anesthesia on adrener-gic tone and the neuroendocrine responses to surgical stress in humans. Anesthesiology. 1981; 55(2): 120-126.
Calvo-Soto P, Martínez-Contreras A, -Hernández BT, And FP, Vásquez C. Spinal–general anaesthesia decreases neuroendo-crine stress response in laparoscopic cholecystectomy. J Int Med Res. 2012; 40: 657-665. doi: 10.1177/147323001204000228
Türker G, Uçkunkaya N, Yavaşçaoğlu B, Yilmazlar A, Ozçe-lik S. Comparison of the catheter-technique psoas compartment block and the epidural block for analgesia in partial hip replace-ment surgery. Acta Anaesthesiol Sc and. 2003; 47: 30-36. doi: 10.1034/j.1399-6576.2003.470106.x
CasatiA, Fanelli G, Koscielniak-Nielsen Z, et al. Using stimu-lating catheters for continuous sciatic nerve block shortens onset time of surgical block and minimizes postoperative consumption of pain medication after halux valgus repair as compared with conventional nonstimulating catheters. Anesth Analg. 2005; 101(4): 1192-1197. doi: 10.1213/01.ane.0000167232.10305.cd
Maurer K, Bonvini JM, Ekatordamis, G, Serena S, Borgeat A. Continuous spinal anesthesia/analgesia vs. single-shot spinal anesthesia with patient-controlled analgesia for elective hip ar-throplasty. Acta Anaesthesiol Sc and. 2003; 47(7): 878-883. doi: 10.1034/j.1399-6576.2003.00173.x
Hadzic A, Arliss J, Kerimoglu B, et al. A Comparison of In-fraclavicular Nerve Block versus General Anesthesia for Hand and Wrist Day-case Surgeries. Anesthesiology. 2004; 101: 127- 132.
Ilfeld BM, Le LT, Meyer RS, et al. Ambulatory continuous femoral nerve blocks decrease time to discharge readiness after tricompartment total knee arthroplasty: a randomized, triple-masked, placebo-controlled study. Anesthesiology. 2008; 108: 703-713. doi: 10.1097/ALN.0b013e318167af46
Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubeno-vitch J, d’Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after ma-jor knee surgery. Anesthesiology. 1999; 91(1): 8-15.
Salinas FV, Liu SS, Mulroy MF. The Effect of single-in-jection femoral nerve block versus continuous femoral nerve block after total knee arthroplasty on hospital length of stay and long-term functional recovery within an established clinical pathway. Anesth Analg. 2006; 102: 1234-1239. doi: 10.1213/01. ane.0000198675.20279.81
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