«Bloqueos continuos del nervio ciático después de la cirugía ambulatoria de pié y tobillo.»
Anderson, Steven R MD 1; Nunley, James A MD 1; Klein, Stephen M MD 2 Abstract: Despite the rapid emergence of less invasive surgical techniques and the subsequent transition of surgery in the United States to the outpatient setting, the large majority of patients are still left to rely on opioid analgesics for postoperative pain control. Peripheral nerve blockade, however, is becoming a more commonly used technique for managing intraoperative and postoperative discomfort. Single-injection peripheral nerve blockade provides patients with adequate analgesia until the block regresses, usually the afternoon or evening of the day of surgery. However, following orthopaedic surgery, pain control is often necessary well beyond the functional lifespan of a single-injection peripheral nerve block. In contrast, a continuous peripheral nerve block delivered via a perineural catheter by a disposable, home infusion pump allows for prolonged analgesia following outpatient foot and ankle surgery. A technique for placing a classic sciatic nerve block and perineural catheter for use during and after ambulatory foot and ankle surgery is discussed. The literature regarding this topic is also reviewed. Patients can be safely discharged with an indwelling peripheral nerve catheter and continuous long-acting local anesthetic infusion if appropriate support and instruction are provided. Concerns do exist, however, surrounding discharging patients with blocked, insensate extremities. Strategies to prevent or minimize any untoward effects from continuous peripheral nerve blockade are further discussed.
Techniques in Foot & Ankle Surgery. 4(1):22-30, March 2005.