Department of Anesthesiology, University of California San Diego, San Diego, California.
Outcomes Research Consortium, Cleveland, Ohio, USA.
Curr Opin Anaesthesiol. 2023 Oct 1;36(5):525-532. doi: 10.1097/ACO.0000000000001284. Epub 2023 Jun 22.
Continuous peripheral nerve blocks (cPNB) decrease pain scores and opioid consumption while improving patient satisfaction following ambulatory surgery. This review focuses on the history and evolution of ambulatory cPNBs, recent developments in infusion technology that may prolong the duration of analgesia, optimal choice of cPNB for various surgical procedures, and novel analgesic modalities that may prove to be alternatives or supplements to cPNBs.
The primary factor limiting the duration of an ambulatory cPNB is the size of the local anesthetic reservoir. Recent evidence suggests the use of automated boluses, as opposed to continuous infusions, may decrease the rate of consumption of local anesthetic and, thereby, prolong the duration of analgesia. Utilizing a long-acting local anesthetic (e.g. ropivacaine) for initial block placement and an infusion start-delay timer may further increase this duration.
Patients undergoing painful ambulatory surgery are likely to have less pain and require fewer opioid analgesics when receiving a cPNB for postoperative analgesia. Advances in electronic pumps used for cPNBs may increase the duration of these benefits.
连续外周神经阻滞（cPNB）可降低疼痛评分和阿片类药物的消耗，同时提高门诊手术后患者的满意度。本综述重点介绍了 cPNB 的历史和演变、可能延长镇痛持续时间的输注技术的最新进展、各种手术程序中 cPNB 的最佳选择以及可能替代或补充 cPNB 的新型镇痛方式。
限制门诊 cPNB 持续时间的主要因素是局部麻醉剂储液器的大小。最近的证据表明，与连续输注相比，使用自动推注可能会降低局部麻醉剂的消耗速度，从而延长镇痛持续时间。最初使用长效局部麻醉剂（例如罗哌卡因）进行阻滞，并使用输注起始延迟定时器可能会进一步延长该时间。
接受疼痛门诊手术的患者在接受 cPNB 进行术后镇痛时，可能疼痛更少，需要的阿片类镇痛药也更少。用于 cPNB 的电子泵的进步可能会延长这些益处的持续时间。
