Regional blocks in orthopaedics

Abstract 

Acute postoperative pain management has played a significant role in decreased hospital stay and has been recognized to have a positive effect on functional recovery and patient satisfaction. Orthopaedic surgery is an expanding surgical specialty with a potentially difficult patient population. Regional anaesthesia is becoming increasingly popular as it offers several advantages over general anaesthesia. The aim of analgesic protocols is not only to reduce pain intensity but also to decrease the incidence of side-effects from analgesic agents and to improve patient comfort. Moreover, adequate pain control is a prerequisite for the use of rehabilitation programmes to accelerate functional recovery from orthopaedic surgery. Recently there has been resurgence in the use of regional anaesthesia as anaesthetists are better equipped with advanced techniques for nerve localization and visualization of needle and local anaesthetic spread hence can prevent side effects secondary to needle misplacement with ultrasound guidance. The use of peripheral nerve blocks has been associated with earlier discharge in ambulatory orthopaedic surgery when compared to general anaesthesia and neuraxial blockade. This article discusses the advantages and limitations of regional anaesthesia for perioperative pain management and various peripheral nerve blocks and catheter techniques used for commonly performed orthopaedic procedures. It also briefly mentions the recent advances in nerve localization techniques. Increased knowledge, training and practice in regional techniques has the benefit of improving analgesia and mobilization, shortened hospital stay and improving overall quality of care. Moreover, increased efficiency and decreased length of hospital stay have positive cost implications.

Keywords: neuraxial blockade, perioperative, peripheral nerve block, plexus, postoperative, regional anaesthesia, ultrasound guidance