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.