Protocols for anesthesia and analgesia

Local anesthetic solutions

Any local anaesthetic solution can be used for this block, as well as various additives to local anesthetic solutions. However, for surgical anesthesia we suggest using a volume of 25 to 30 ml whereas for analgesia purposes, a volume of 20 ml of anaesthetic solution will suffice.

Induction
20 to 30 ml of anaesthetic solution are adequate.

Maintenance of postoperative analgesia
     1. Intermittent injections:
         20 ml of anaesthetic solution (Ropivacaïne 0.2% without adrenalin or Bupivacaïne
         0.25% adrénalinée) with 50 mG of clonidine. Two to three times a day.
     2. Continuous infusion:
         Ropivacaïne 0.2% or Bupivacaïne 0.25%: 10 ml per hour
     3. PCA
         Ropivacaïne 0.2% or Bupivacaïne 0.25% : 5 ml per hour and bolus of 10ml/30mn.
         Monitoring
     4. Observe for absence of epidural spread (bilateralisation of the block).
         Hemodynamic consequences (epidural spread)
         Assistance at the time of getting out of bed is essential: risk of fall.