Rationale For Use of Lower Extremity Conduction Nerve Blocks

Surgical pain components

Postoperative pain is multifactorial and results from several conditions including: 1) skin and muscle trauma, trauma to the fascias, periosteum and bones (somatic pain); 2) ischemia of mesenteric vessels and traction of peritoneum (visceral pain); 3) local inflammatory disorders and spinal reflexes (inflammation and neural plasticity); and 4) joint mobilizations, wound dressings, venepunctures and other types of procedural pain.

Postoperative pain depends both on central sensitization [5,6] and an input from the periphery (tissue trauma).[7,8] Prevention and treatment of the persistent pain should focus on targe-ting both central sensitization (e.g., opioids), as well as active peripheral nerve nociceptive input. The latter goal at present can be reliably achieved only by interrupting the transmission from the peripheral nerve fibers supplying the injured area. Of note, while parenteral opioids and regional blocks techniques are equally effective on postoperative pain at rest, only regional blocks can 1) suppress pain on mobilization of patients and procedural pain, and 2) prevent inflammatory disorders and neural plasticity.[9]


 

Abstract

Introduction

Rationale

Indications

Contra-indications

Equipment

Techniques

Summary

References