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 Most patients
have more than one mode of pain control after surgery--usually some combination
of epidural anesthesia, perineural anesthesia and intravenous morphine.
With this regimen, our patients usually have minimal post-operative pain.
Perineural
(also called "epineural") analgesia is the use of a small catheter,
inserted at the time of surgery, to deliver a continuous infusion of non-narcotic
anesthetic directly onto the nerve supplying the surgical area.
The use of perineural analgesia for limb-sparing surgery was pioneered
by the Washington Musculoskeletal Tumor Center. We have routinely used
perineural analgesia for over a decade and found that it significantly
reduces patients' pain and their need for narcotics.
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Related
Publications |
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Henshaw R.,
Levy NA, Kellar-Graney KL, Malawer MM: Regional Postoperative Analgesia
Via Indwelling Epineural Catheters Following Major Limb Sparing Resections
and Amputations: Analysis of 166 Patients. In Meeting of the
American Academy of Orthopedic Surgeons, Edited, Poster 498, Dallas,
TX, 2002.
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PURPOSE:
To determine the efficacy of continuous epineural infusion
of nonnarcotic analgesic for postoperative pain management.
METHODS:
In a single institution retrospective study, 166 patients
who had received epineural catheters were identified and analyzed
for narcotic usage and subjective pain ratings after major
limb sparing resections or amputations.
CONCLUSIONS:
Epineural catheters may be safely inserted into amputated
nerve stumps as well as intact peripheral nerve sheaths without
complications. Furthermore, they can provide dramatic regional
postoperative analgesia compared to lumbar epidurals and minimize
narcotic use.
CLICK HERE TO DOWNLOAD THE POSTER IN PDF FORMAT
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Malawer M.:
Postoperative Continuous Regional Analgesia - A Technique for
Relief of Postoperative Pain Following a Major Extremity Surgery.
Clinical Orthopedics and Related Research, 266: 227-237, 1991.
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A new technique using postoperative infusional continuous regional analgesia (PICRA) for postoperative pain relief was investigated in 23 surgical patients treated by amputation (12 patients) or by limb-salvage resection operations (11 patients). Bupivacaine was delivered into peripheral nerve sheaths via cathetersa placed therein at the time of surgery. Only patients in whom the nerves were easily accessible were treated. Catheters were placed in the axillary sheath, the lumbosacral trunk, and the femoral nerve sheaths of patients treated with shoulder girdle and pelvic procedures (resections and amputations), and within the sciatic nerve sheath of those treated with lower extremity procedures. The anesthetic agent was delivered at controllable rates. Regional analgesia was obtained in the operative site with minimal motor or sensory decrease. To assess the efficacy of this technique, the results of this study group were compared with those of a matched group of 11 patients treated with similar surgical procedures but who received epidural morphine. Eleven of the 23 patients on PICRA required no supplemental narcotic agents. The mean level of the narcotic agents required by the remaining 13 PICRA patients was approximately one third of that required by the matched group of 11 patients receiving epidural morphine. Overall, the patients on PICRA had an 80% reduction of narcotic requirements when compared to the historical controls. The technique is reliable and can be performed by the surgeon, requiring about a ten-minute increase in operating time. It has potentially wide application in orthopedics in procedures in which the major nerves are easily accessible (e.g. pelvic fractures and revision hip surgery) and for patients with intractable pain of the extremities.
CLICK HERE TO DOWNLOAD THE ARTICLE IN PDF FORMAT
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