Peripheral neuronal blockade. A review of new developments of an old technique

Citation
Bm. Graf et E. Martin, Peripheral neuronal blockade. A review of new developments of an old technique, ANAESTHESIS, 50(5), 2001, pp. 312-322
Citations number
98
Language
TEDESCO
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care
Journal title
ANAESTHESIST
ISSN journal
0003-2417 → ACNP
Volume
50
Issue
5
Year of publication
2001
Pages
312 - 322
Database
ISI
SICI code
0003-2417(200105)50:5<312:PNBARO>2.0.ZU;2-D
Abstract
General anaesthesia and peripheral neuronal blockade are techniques which w ere introduced into clinical practice at the same time. Although general an aesthesia was accepted significantly faster due to effective new drugs and apparent ease of handling, neuronal blockade has recently gained great impo rtance. The reasons are in particular newer aids such as industrially produ ced catheter sets, nerve stimulators and ultrasound guidance which have fac ilitated that these economical techniques can be used not only for intraope rative anaesthesia but also for perioperative analgesia without any major r isks for the patients. In parallel to epidural anaesthesia a change of para digms has recently taken place using catheter instead of single-shot techni ques. This allows the loading dose of the local anaesthetics to be installe d in a safe way, to reload the dose when intraoperatively required and to e xtend the analgesia perioperatively by this technique using lower concentra tions of the same drugs or drug combinations. A great number of short, midd le or long acting local anaesthetics are available to choose the right drug for any particular case. Short and middle acting drugs are characterised b y a faster onset compared to long acting drugs, but toxic plasma levels are seen during long time application causing seizures or drowsiness or by usi ng prilocaine methemoglobin. Therefore long acting local anaesthetics such as bupivacaine, ropivacaine or levobupivacaine are the first choice drugs f or long time application via peripheral nerve catheters for perioperative a naesthesia and analgesia. By using low concentrations of these potent drugs even for a longer period of time, no toxic plasma levels are seen with the exception of artificial intravasal injections. Additives such as opioids a nd alpha (2)-sympathomimetics are also used. While the use of opioids is co ntroversial, alpha (2)-sympathomimetics are able to accelerate the onset an d to extend the duration of regional anaesthesia and analgesia.