الفهرس 
Anatomical considerationsOnly 14 pages are availabe for public view
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Abstract
There has been a growing interest in the practice of regional anesthesia and, in particular, peripheral nerve blocks for surgical anesthesia and postoperative analgesia. When using non–stimulating catheter technique an insulating needle is advanced near the nerve with nerve stimulator guidance. Once the physician satisfied with the position of the needle tips saline or local anesthetic is injected to expand the potential perineural space a typical epidural catheter is then advanced through the needle.
During the stimulating catheter technique an indulated needle (typically a touhy) 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.
This technique has a few more step to perform, the primary success rate with this technique probably equal that of the traditional technique but with a higher secondary block success rate.
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. Tunneling without a skin bridge is used for long-term use (4-14 days), while tunneling with a skin bridge is for shorter-term use (1-3 days).
To remove the catheter, if no skin bridge has been left, the proximal end is gently pulled while applying counter skin traction with the other hand. If a skin bridge has been left, the catheter is taken at the bridge with a sterile forceps, while ensuring that the proximal end does not go in deeper, and the distal end of the catheter is removed. Thereafter, the rest of the catheter is removed by simply pulling it out this must be carried out using a sterile technique.
. Most complications of regional anesthesia are relatively minor, easily managed and temporary but in rare instances serious and permanent damage occurs.
In contrast to other anesthetic techniques, such as general or spinal anesthesia, properly conducted peripheral nerve blocks avoid hemodynamic instability and pulmonary complications.
Continuous peripheral nerve block are increasingly being utilized in the management of moderate to severe pain following upper and lower limb surgery. It is important and perhaps superior modalities to supplement or even replace oral and intravenous analgesic for control of intense intra and post surgical pain .
When using non–stimulating catheter technique an insulating needle is advanced near the nerve with nerve stimulator guidance. Once the physician satisfied with the position of the needle tips saline or local anesthetic is injected to expand the potential perineural space a typical epidural catheter is then advanced through the needle.
During the stimulating catheter technique an indulated needle (typically a touhy) 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.
This technique has a few more step to perform, the primary success rate with this technique probably equal that of the traditional technique but with a higher secondary block success rate.
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. Tunneling without a skin bridge is used for long-term use (4-14 days), while tunneling with a skin bridge is for shorter-term use (1-3 days).
To remove the catheter, if no skin bridge has been left, the proximal end is gently pulled while applying counter skin traction with the other hand. If a skin bridge has been left, the catheter is taken at the bridge with a sterile forceps, while ensuring that the proximal end does not go in deeper, and the distal end of the catheter is removed. Thereafter, the rest of the catheter is removed by simply pulling it out this must be carried out using a sterile technique.
When using non–stimulating catheter technique an insulating needle is advanced near the nerve with nerve stimulator guidance. Once the physician satisfied with the position of the needle tips saline or local anesthetic is injected to expand the potential perineural space a typical epidural catheter is then advanced through the needle.
During the stimulating catheter technique an indulated needle (typically a touhy) 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.
This technique has a few more step to perform, the primary success rate with this technique probably equal that of the traditional technique but with a higher secondary block success rate.
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. Tunneling without a skin bridge is used for long-term use (4-14 days), while tunneling with a skin bridge is for shorter-term use (1-3 days).
To remove the catheter, if no skin bridge has been left, the proximal end is gently pulled while applying counter skin traction with the other hand. If a skin bridge has been left, the catheter is taken at the bridge with a sterile forceps, while ensuring that the proximal end does not go in deeper, and the distal end of the catheter is removed. Thereafter, the rest of the catheter is removed by simply pulling it out this must be carried out using a sterile technique.
In contrast to other anesthetic techniques, such as general or spinal anesthesia, properly conducted peripheral nerve blocks avoid hemodynamic instability and pulmonary complications.