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Management of peripheral nerve block catheters at home.

This chapter could not have been written 10 years ago. At that time, peripheral continuous regional anesthesia (CRA) was still in its infancy, and the thought of sending patients home with indwelling catheters was unimaginable. Since then, many dedicated authors and practitioners worldwide have revolutionized patient care by implementing a new method of pain treatment that allows patients having painful surgical procedures to enjoy the possibility of sooner, comfortable hospital discharge, including discharge on the same day of surgery. The concept ofmultimodal analgesia with local anesthetics as the base technique has evolved to include CRA, and now further to ambulatory CRA. We present data confirming the need for these techniques, as well as guidelines for safe utilization in the ambulatory setting. Surgical procedures such as herniorrhaphy and orthopedic surgery have been shown (through patient surveys) for several years now to be associated with a high incidence of moderate to severe postoperative pain. A more recent study confirmed that 30% of patients have moderate to severe pain 24 hours after ambulatory surgery. Procedures cited included orthopedic procedures such as shoulder, elbow, hand, and knee procedures. Choosing regional or general anesthesia as the primary anesthetic for these procedures did not influence the degree of postoperative pain reported. Thus, unfortunately, single-injection regional anesthesia used for procedures associated with moderate to severe postoperative pain only delays pain until the block recedes. CRA was developed to continue the benefits of regional anesthesia well into the postoperative period, allowing a smooth transition to less potent oral opioid and nonopioid analgesics. CRA has been successfully used in many procedures, including shoulder surgery, foot surgery, and knee