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التصفح حسب الموضوعات
التصفح حسب اللغة
التصفح حسب الناشر
التصفح حسب تاريخ النشر
التصفح حسب مكان النشر
التصفح حسب المؤلفين
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Thesis 2015
ElSabagh,Dina Ahmed Mohamed
617 الجراحة والموضوعات ذات الصلة  
A continuous peripheral nerve block - involves the percutaneous insertion of a catheter adjacent to a peripheral nerve - followed by local anesthetic administration via the catheter - providing potent site-specific anesthesia / analgesia for more than 24 hours. A continuous peripheral nerve block (CPNB) may provided in the hospital and at home as well.
The most common use of CPNBs is in the peri- and postoperative period but different indications have been described like the treatment of intractable hiccup - treatment of chronic pain such as cancer-induced pain - complex regional pain syndrome. Continuous peripheral nerve blocks should be absolutely avoided if the patient refused - in cases of active infection at the site of needle insertion - allergy to local anesthetic and inability to guarantee sterile equipment to perform the block.
The documented benefits strongly depend on the analgesia quality and include potent site-specific analgesia - possibility of prolonging intraoperative anesthesia - reducing additional analgesic requirements - decrease of sleep disturbances and opioid-related side effects - increase of patient satisfaction and ambulation/functioning improvement - an accelerated resumption of passive joint range-of-motion - reducing time until discharge readiness and reduction of costs.
During the stimulating catheter technique an insulated needle is similarly placed near the nerve to be blocked with nerve stimulator guidance - no bolus injection at the time of needle placement - rather a catheter with an electrically conductive tip is advanced through the needle while being stimulated.
If catheter is correctly placed; it does not mean that it will remain in that position. Most catheters dislodge or fall out. The only fixation method that has stood the test of time is that of subcutaneous tunneling - which can be done with or without leaving a small skin bridge.
The introduction of ultrasound for regional anesthesia has been an important development. First it was considered a supplement to nerve stimulation - now it is recognized as a “stand-alone” technique. Ultrasound-guided CPNB techniques may be performed in a variety of locations: along the brachial plexus - femoral nerve - sciatic nerve and paravertebral plexus. Essentially - perineural catheters may be placed in the vicinity of nearly all peripheral nerves for continuous local anesthetic infusion using ultrasound guidance.
The reported incidence of complications after peripheral nerve block is generally low. CPNB-Specific Complications include local anesthetic toxicity - hemorrhagic - infectious and neurological Complications. Measures recommended for minimizing complications are the use of strict asepsis - the wise choice of local anesthetic - the experience with single shot technique - the availability of emergency facilities and avoidance of intravascular injection
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