Regional Anesthesia Complications Related to Acute Pain Management

  • Narinder Rawal


There is a large variety of available routes for administration of analgesic drugs to manage postoperative pain; these include: enteral (oral, sublingual, buccal, transmucosal), rectal, parenteral [subcutaneous, intramuscular (i.m.), intravenous (i.v.)], surface (topical, transdermal), cavity (intranasal, inhalational, intra-articular), and neural (neuraxial and peripheral) routes. Table 16-1 shows the regional techniques available to manage postoperative pain. The problems associated with regional techniques generally are covered elsewhere in this book; these include technique-related issues, infection, nerve injury, systemic local anesthetic (LA) toxicity, etc. Also, it is clear that “epidural analgesia” is not a generic term. Its effects on outcome and complications may differ depending on whether epidural injections consist of opioids, LAs, or both. In addition, the insertion site for the epidural catheter (lumbar, low thoracic, or high thoracic) will significantly alter physiologic effects when LAs are used.


Respiratory Depression Epidural Analgesia Epidural Catheter Epidural Morphine Intrathecal Morphine 


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  1. 1.
    Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology 2004;101:950–959.PubMedCrossRefGoogle Scholar
  2. 2.
    Hasserius R, Johnell O, Nilsson BE, et al. Hip fracture patients have more vertebral deformities than subjects in population-based studies. Bone 2003;32:180–184.PubMedCrossRefGoogle Scholar
  3. 3.
    Wang LP, Hauerberg J, Schmidt JF. Incidence of spinal epidural abscess after epidural analgesia: a national 1-year survey. Anesthesiology 1999;91:1928–1940.PubMedCrossRefGoogle Scholar
  4. 4.
    Wheatley RG, Schug SA, Watson D. Safety and efficacy of postoperative analgesia. Br J Anaesth 2001;87:47–61.PubMedCrossRefGoogle Scholar
  5. 5.
    Werner MU, Søholm L, Rotbøll-Nielsen P. Does an acute pain service improve postoperative outcome? Anesth Analg 2002;95:1361–1372.PubMedCrossRefGoogle Scholar
  6. 6.
    Rawal N. Acute pain services revisited: good from far, far from good? Reg Anesth Pain Med 2002;27:117–121.PubMedGoogle Scholar
  7. 7.
    Rawal N. Organization, function, and implementation of acute pain service. Anesthesiol Clin North Am 2005;23:211–225.CrossRefGoogle Scholar
  8. 8.
    Shug SA, Torrie JJ. Safety assessment of postoperative pain management by an acute pain service. Pain 1993;55:6–21.Google Scholar
  9. 9.
    Wheatley RG, Madej TH, Jackson IJ, Hunter D. The first year’s experience of an acute pain service. Br J Anaesth 1991;67:353–359.PubMedCrossRefGoogle Scholar
  10. 10.
    Maier C, Kibbel K, Mercker S, Wulf H. Postoperative pain therapy at general nursing stations: an analysis of eight years’ experience at an anesthesiological acute pain service. Anaesthesist 1994;43:385–397.PubMedCrossRefGoogle Scholar
  11. 11.
    Brodner G, Mertes N, Buerkle H, et al. Acute pain management: analysis, implications and consequences after prospective experience with 6349 surgical patients. Eur J Anaesthesiol 2000;17:566–575.PubMedGoogle Scholar
  12. 12.
    Breivik H. Benefit, risks and economics of postoperative pain management programmes. In: Breivik H, ed. Baillière’s Clinical Anaesthesiology. Vol 9. London: Bailiière Tindali; 1995:403–460.Google Scholar
  13. 13.
    Burstal R, Wegener F, Hayes C, Lantry G. Epidural analgesia: prospective audit of 1062 patients. Anaesth Intensive Care 1998;26:165–172.PubMedGoogle Scholar
  14. 14.
    Breivik H, Högström H, Niemi G, et al. Safe and effective postoperative pain relief: introduction and continuous quality-improvement of comprehensive postoperative pain management programmes. In: Breivik H, ed. Baillière’s Clinical Anaesthesiology. London: Baillière Tindall; 1995:423–460.Google Scholar
  15. 15.
    Chen PP, Ma M, Chan S, Oh TE. Incident reporting in acute pain management. Anaesthesia 1998;53:730–735.PubMedCrossRefGoogle Scholar
  16. 16.
    Blanco J, Blanco E, Rodriguez G, et al. One year’s experience with an acute pain service in a Spanish University Clinic hospital. Eur J Anaesthesiol 1994;11:417–421.PubMedGoogle Scholar
  17. 17.
    Tsui SL, Irwin MG, Wong CM, et al. An audit of the safety of an acute pain service. Anaesthesia 1997;52:1042–1047.PubMedCrossRefGoogle Scholar
  18. 18.
    Bredahl C, Dahl BL, Toft P. Acute pain service: organization and results. Ugeskr Laeger 1998;160:6070–6074.PubMedGoogle Scholar
  19. 19.
    Sartain JB, Barry JJ. The impact of an acute pain service on postoperative pain management. Anaesth Intensive Care 1999;27:375–380.PubMedGoogle Scholar
  20. 20.
    De Leon-Casasola OA, Parker B, Lema MJ, et al. Postoperative epidural bupivacaine-morphine therapy. Experience with 4227 surgical cancer patients. Anesthesiology 1994;81:368–375.PubMedCrossRefGoogle Scholar
  21. 21.
    Rygnestad T, Borchgrevink PC, Eide E. Postoperative epidural infusion of morphine and bupivacaine is safe on surgical wards. Organisation of the treatment, effects and side-effects in 2000 consecutive patients. Acta Anaesthesiol Scand 1997;41:868–876.PubMedCrossRefGoogle Scholar
  22. 22.
    Scott DA, Beilby DS, McClymont C. Postoperative analgesia using epidural infusions of fentanyl with bupivacaine. A prospective analysis of 1014 patients. Anesthesiology 1995; 83:727–737.PubMedCrossRefGoogle Scholar
  23. 23.
    Cohen S, Amar D, Pantuck CB, et al. Adverse effects of epidural 0.03% bupivacaine during analgesia after cesarean section. Anesth Analg 1992;75:753–756.PubMedGoogle Scholar
  24. 24.
    Punt CD, van Neer PA, de Lange S. Pressure sores as a possible complication of epidural analgesia. Anesth Analg 1991;73:657–659.PubMedCrossRefGoogle Scholar
  25. 25.
    Smet IG, Vercauteren MP, De Jongh RF, et al. Pressure sores as a complication of patient-controlled epidural analgesia after cesarean delivery. Case report. Reg Anesth 1996;21: 338–341.PubMedGoogle Scholar
  26. 26.
    Liu SS, Moore JM, Luo AM, et al. Comparison of three solutions of ropivacaine/fentanyl for postoperative patient-controlled epidural analgesia. Anesthesiology 1999;90:727–733.PubMedCrossRefGoogle Scholar
  27. 27.
    Wu CL, Thomsen RW. Effect of postoperative epidural analgesia on patient outcomes. Tech Reg Anesth Pain Manage 2003;7:140–147.CrossRefGoogle Scholar
  28. 28.
    Davis RF, DeBoer LW, Maroko PR. Thoracic epidural anesthesia reduces myocardial infarct size after coronary artery occlusion in dogs. Anesth Analg 1986;65:711–717.PubMedCrossRefGoogle Scholar
  29. 29.
    Kock M, Blomberg S, Emanuelsson H, et al. Thoracic epidural anesthesia improves global and regional left ventricular function during stress-induced myocardial ischemia in patients with coronary artery disease. Anesth Analg 1990;71:625–630.PubMedCrossRefGoogle Scholar
  30. 30.
    Veering BT, Cousins MJ. Cardiovascular and pulmonary effects of epidural anaesthesia. Anaesth Intensive Care 2000;28:620–635.PubMedGoogle Scholar
  31. 31.
    Beattie WS, Badner NH, Choi P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg 2001;93:853–858.PubMedCrossRefGoogle Scholar
  32. 32.
    Hodgson PS, Liu SS. Thoracic epidural anaesthesia and analgesia for abdominal surgery: effects on gastrointestinal function and perfusion. Balliere’s Clin Anaesthesiol 1999; 13:9–22.Google Scholar
  33. 33.
    Miguel R, Barlow I, Morrell M, et al. A prospective, randomized, double-blind comparison of epidural and intravenous sufentanil infusions. Anesthesiology 1994;81:346–352.PubMedCrossRefGoogle Scholar
  34. 34.
    Seeling W, Heinrich H. Unexpected intravenous penetration of an epidural catheter. Reg Anaesth 1984;7:137–139.PubMedGoogle Scholar
  35. 35.
    Chauhan S, Gaur A, Tripathi M, Kaushik S. Unintentional combined epidural and subdural block. Case report. Reg Anesth 1995;20:249–251.PubMedGoogle Scholar
  36. 36.
    Ready LB, Loper KA, Nessly M, Wild L. Postoperative epidural morphine is safe on surgical wards. Anesthesiology 1991;75:452–456.PubMedCrossRefGoogle Scholar
  37. 37.
    Schug SA, Torrie JJ. Safety assessment of postoperative pain management by an acute pain service. Pain 1993;55:387–391.PubMedCrossRefGoogle Scholar
  38. 38.
    Bizat Z, Boztug N, Onder G, Ertok E. A rare complication of epidural catheter. Acta Anaesthesiol Scand 2005;49:589–590.CrossRefGoogle Scholar
  39. 39.
    Whiteley MH, Laurito CE. Neurologic symptoms after accidental administration of epidural glucose. Anesth Analg 1997;84:216–217.PubMedGoogle Scholar
  40. 40.
    Kopacz DJ, Slover RB. Accidental epidural cephazolin injection: safeguards for patient-controlled analgesia. Anesthesiology 1990;72:994–997.CrossRefGoogle Scholar
  41. 41.
    Cay DL. Accidental epidural thiopentone. Anaesth Intensive Care 1984;12:61–63.PubMedGoogle Scholar
  42. 42.
    Forestner JE, Raj PP. Inadvertent epidural injection of thiopental: a case report. Anesth Analg 1975;54:406–407.PubMedCrossRefGoogle Scholar
  43. 43.
    Kulka PJ, Stratesteffen I, Grunewald R, Wiebalck A. Inadvertent potassium chloride infusion in an epidural catheter. Anaesthesist 1999;48:896–899.PubMedCrossRefGoogle Scholar
  44. 44.
    Lin D, Becker K, Shapiro HM. Neurologic changes following epidural injection of potassium chloride and diazepam: a case report with laboratory correlations. Anesthesiology 1986;65:210–212.PubMedCrossRefGoogle Scholar
  45. 45.
    Shanker KB, Palkar NV, Nishkala R. Paraplegia following epidural potassium chloride. Anaesthesia 1985;40:45–47.PubMedCrossRefGoogle Scholar
  46. 46.
    Patel PC, Sharif AM, Farnando PU. Accidental infusion of total parenteral nutrition solution through an epidural catheter. Anaesthesia 1984;39:383–384.PubMedCrossRefGoogle Scholar
  47. 47.
    Brown DL, Ransom DM, Hall JA, et al. Regional anesthesia and local anesthetic-induced systemic toxicity: seizure frequency and accompanying cardiovascular changes. Anesth Analg 1995;81:321–328.PubMedGoogle Scholar
  48. 48.
    Tanaka K, Watanabe R, Harada T, Dan K. Extensive application of epidural anesthesia and analgesia in a university hospital: incidence of complications related to technique. Reg Anesth 1993;18:34–38.PubMedGoogle Scholar
  49. 49.
    Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology 1984;61:276–310.PubMedCrossRefGoogle Scholar
  50. 50.
    Morgan M. The rational use of intrathecal and extradural opioids. Br J Anaesth 1989;63: 165–188.PubMedCrossRefGoogle Scholar
  51. 51.
    Rawal N. Spinal opioids. In: Raj PP, ed. Practical Management of Pain. St. Louis: Mosby Year Book; 1992:829–851.Google Scholar
  52. 52.
    Vercauteren MP. The role of perispinal route for postsurgical pain relief. Balliere’s Clin Anaesth 1993;7:769–792.CrossRefGoogle Scholar
  53. 53.
    Rawal N, Allvin R, EuroPain Study Group on Acute Pain. Epidural and intrathecal opioids for postoperative pain management in Europe — a 17-nation questionnaire study of selected hospitals. Acta Anaesthesiol Scand 1996;40:1119–1126.PubMedCrossRefGoogle Scholar
  54. 54.
    Brockway MS, Noble DW, Sharwood-Smith GH, McClure JH. Profound respiratory depression after extradural fentanyl. Br J Anaesth 1990;64:243–245.PubMedCrossRefGoogle Scholar
  55. 55.
    Weightman WM. Respiratory arrest during fentanyl infusion of bupivacaine and fentanyl. Anaesth Intensive Care 1991;19:282–284.PubMedGoogle Scholar
  56. 56.
    Scott DA, Beilby DSN, McClymont C. Postoperative analgesia using epidural infusions of fentanyl with bupivacaine. Anesthesiology 1995;83:727–737.PubMedCrossRefGoogle Scholar
  57. 57.
    Burstal R, Wegener F, Hayes C, Lantry G. Epidural analgesia: prospective audit of 1062 patients. Anaesth Intensive Care 1998;26:165–172.PubMedGoogle Scholar
  58. 58.
    Liu SS, Allen HW, Olsson GL. Patient-controlled epidural analgesia with bupivacaine and fentanyl on hospital wards: prospective experience with 1030 surgical patients. Anesthesiology 1998;88:688–695.PubMedCrossRefGoogle Scholar
  59. 59.
    Wigfull J, Welchew E. Survey of 1057 patients receiving postoperative patient-controlled epidural analgesia. Anaesthesia 2001;56:47–81.CrossRefGoogle Scholar
  60. 60.
    Ostermeier AM, Roizen MF, Hautkappe M, et al. Three sudden postoperative respiratory arrests associated with epidural opioids in patients with sleep apnea. Anesth Analg 1997;85:452–460.PubMedGoogle Scholar
  61. 61.
    Broekema A A, Gielen MJM, Hennis PJ. Postoperative analgesia with continuous epidural sufentanil and bupivacaine: a prospective study in 614 patients. Anesth Analg 1996; 82:754–779.PubMedGoogle Scholar
  62. 62.
    Eisenach JC. Lipid soluble opioids do move in cerebrospinal fluid. Reg Anesth Pain Med 2001;26:296–297.PubMedGoogle Scholar
  63. 63.
    Bernards CM. Recent insights into the pharmacokinetics of spinal opioids and the relevance to opioid selection. Curr Opin Anaesthesiol 2004;17:441–447.PubMedCrossRefGoogle Scholar
  64. 64.
    Ginosar Y, Riley ET, Angst MS. The site of action of epidural fentanyl in humans: the difference between infusion and bolus administration. Anesth Analg 2003;97:1428–1438.PubMedCrossRefGoogle Scholar
  65. 65.
    Parker RK, White PF. Epidural patient-controlled analgesia: an alternative to intravenous patient-controlled analgesia for pain relief after caesarean delivery. Anesth Analg 1992; 75:245–251.PubMedGoogle Scholar
  66. 66.
    Torda TA, Hann P, Mills G, et al. Comparison of extra-dural fentanyl, bupivacaine and two fentanyl-bupivacaine mixtures for pain relief after abdominal surgery. Br J Anaesth 1995;74:35–40.PubMedCrossRefGoogle Scholar
  67. 67.
    Grass JA. Sufentanil: clinical use as postoperative analgesic — epidural-intrathecal route. J Pain Symptom Manage 1992;7:271–286.PubMedCrossRefGoogle Scholar
  68. 68.
    Bannon L, Alexander-Williams M, Lutman D. A national survey of epidural practice. Anaesthesia 2001;56(10):1021.PubMedCrossRefGoogle Scholar
  69. 69.
    Gaffud MP, Bansal P, Lawton C, et al. Surgical analgesia for caesarean delivery with epidural bupivacaine and fentanyl. Anesthesiology 1986;65:331–334.PubMedCrossRefGoogle Scholar
  70. 70.
    Bush DJ, Kramer DP. Intravascular migration of an epidural catheter during patient-controlled epidural analgesia. Anesth Analg 1993;76:1150–1151.PubMedCrossRefGoogle Scholar
  71. 71.
    Stoelting RK. Intrathecal morphine: an underused combination for postoperative pain management. Anesth Analg 1989;68:707–709.PubMedCrossRefGoogle Scholar
  72. 72.
    Dahl JB, Jeppesen IS, Jørgensen H, et al. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing caesarean section with spinal anesthesia. A qualitative and quantitative systematic review of randomized controlled trials. Anesthesiology 1999;91:1919–1927.PubMedCrossRefGoogle Scholar
  73. 73.
    Mason N, Gondret R, Junca A, Bonnet F. Intrathecal sufentanil and morphine for post-thoracotomy pain relief. Br J Anaesth 2001;86:236–240.PubMedCrossRefGoogle Scholar
  74. 74.
    Campbell DC, Riben CM, Rooney ME, et al. Intrathecal morphine for postpartum tubal ligation postoperative analgesia. Anesth Analg 2001;93:1006–1011.PubMedCrossRefGoogle Scholar
  75. 75.
    Gall O, Aubineau J V, Bernière J, et al. Analgesic effect of low-dose intrathecal morphine after spinal fusion in children. Anesthesiology 2001;94:447–452.PubMedCrossRefGoogle Scholar
  76. 76.
    O’Neill P, Knickenberg C, Bogahalanda S, Booth AE. Use of intrathecal morphine for postoperative pain relief following lumbar spine surgery. J Neurosurg 1985;63:413–416.CrossRefGoogle Scholar
  77. 77.
    Holmström B, Laugaland K, Rawal N, Hallberg S. Combined spinal epidural block versus spinal and epidural block for orthopedic surgery. Can J Anaesth 1993;40: 601–606.PubMedCrossRefGoogle Scholar
  78. 78.
    Kjellberg F, Tramèr MR. Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials. Eur J Anaesth 2001;18:346–357.Google Scholar
  79. 79.
    Waxier B, Dadabhoy ZP, Stojiljkovic L. Primer of postoperative pruritus for anesthesiologists. Anesthesiology 2005;103:168–178.CrossRefGoogle Scholar
  80. 80.
    Rawal N, Möllefors K, Axelsson K, et al. An experimental study of urodynamic effects of epidural morphine and of naloxone reversal. Anesth Analg 1983;62:641–647.PubMedCrossRefGoogle Scholar
  81. 81.
    Bailey PL, Rhondeau S, Schafer PG, et al. Dose-response pharmacology of intrathecal morphine in human volunteers. Anesthesiology 1993;79:49–59.PubMedCrossRefGoogle Scholar
  82. 82.
    Martin R, Salbaing J, Blaise G, et al. Epidural morphine for postoperative pain relief: a dose-response curve. Anesthesiology 1982;56:423–426.PubMedCrossRefGoogle Scholar
  83. 83.
    Stenseth R, Sellevold O, Breivik H. Epidural morphine for postoperative pain: experience with 1085 patients. Acta Anaesthesiol Scand 1985;29:148–156.PubMedCrossRefGoogle Scholar
  84. 84.
    Peterson TK, Husted SE, Rybro L, et al. Urinary retention during i.m. and extradural morphine analgesia. Br J Anaesth 1982;54:1175–1178.CrossRefGoogle Scholar
  85. 85.
    Liu S, Chiu AA, Carpenter RL, et al. Fentanyl prolongs lidocaine spinal anesthesia without prolonging recovery. Anesth Analg 1995;80:730–734.PubMedGoogle Scholar
  86. 86.
    Ben-David B, Solomon E, Levin H, et al. Intrathecal fentanyl with small dose dilute bupivacaine: better anesthesia without prolonging recovery. Anesth Analg 1997;85:560–565.PubMedGoogle Scholar
  87. 87.
    Lau WC, Green CR, Faerber GJ, et al. Intrathecal sufentanil for extracorporeal shock wave lithotripsy provides earlier discharge of the outpatient than intrathecal lidocaine. Anesth Analg 1997;84:1227–1231.PubMedGoogle Scholar
  88. 88.
    Chiu AA, Liu S, Carpenter RL, et al. The effects of epinephrine on lidocaine spinal anesthesia: a cross-over study. Anesth Analg 1995;80:735–739.PubMedGoogle Scholar
  89. 89.
    Hamber EA, Viscomi CM. Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth Pain Med 1999;24:255–263.PubMedGoogle Scholar
  90. 90.
    Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth 1995;42: 891–903.PubMedCrossRefGoogle Scholar
  91. 91.
    Pan MH, Wei TT, Shieh BS. Comparative analgesic enhancement of alfentanil, fentanyl, and sufentanil to spinal tetracaine anesthesia for caesarean delivery. Acta Anaesthesiol Sin 1994;32:171–176.PubMedGoogle Scholar
  92. 92.
    Dahlgren G, Hultstrand C, Jakobsson J, et al. Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. Anesth Analg 1997;85:1288–1293.PubMedGoogle Scholar
  93. 93.
    Palmer CM, Voulgaropoulos D, Alves D. Subarachnoid fentanyl augments lidocaine spinal anesthesia for cesarean delivery. Reg Anesth 1995;20:389–394.PubMedGoogle Scholar
  94. 94.
    Cooper D, Lindsay S, Ryall D, et al. Does intrathecal fentanyl produce acute crosstolerance to IV morphine? Br J Anaesth 1997;78:311–313.PubMedGoogle Scholar
  95. 95.
    Manullang TR, Viscomi CM, Pace NL. Intrathecal fentanyl is superior to intravenous ondansetron for the prevention of perioperative nausea during caesarean delivery with spinal anesthesia. Anesth Analg 2000;90:1162–1166.PubMedCrossRefGoogle Scholar
  96. 96.
    Etches RC, Sandler AN, Daley MD. Respiratory depression and spinal opioids. Can J Anaesth 1989;36:165–185.PubMedCrossRefGoogle Scholar
  97. 97.
    Ko S, Goldstein DH, Van Den Kerkhof EG. Definitions of “respiratory depression” with intrathecal morphine postoperative analgesia: a review of literature. Can J Anaesth 2003;50:679–688.PubMedCrossRefGoogle Scholar
  98. 98.
    Curry PD, Pacsoo C, Heao DG. Patient-controlled epidural analgesia in obstetric anaesthetic practice. Pain 1994;57:125–128.PubMedCrossRefGoogle Scholar
  99. 99.
    Etches RC. Respiratory depression associated with patient-controlled analgesia: a review of eight cases. Can J Anaesth 1994;41:125–132.PubMedCrossRefGoogle Scholar
  100. 100.
    Gustafsson LL, Schildt B, Jacobsen K. Adverse effects of extradural and intrathecal opiates: report of a nation-wide survey in Sweden. Br J Anaesth 1982;54:479–486.PubMedCrossRefGoogle Scholar
  101. 101.
    Stenseth R, Sellevold O, Breivik H. Epidural morphine for postoperative pain relief: experience with 1085 patients. Acta Anaesthesiol Scand 1985;29:148–156.PubMedCrossRefGoogle Scholar
  102. 102.
    Rawal N, Arnér S, Gustafsson LL, et al. Present state of epidural and intrathecal opiate analgesia: a nation-wide follow-up survey in Sweden. Br J Anaesth 1987;59:791–799.PubMedCrossRefGoogle Scholar
  103. 103.
    Fuller JG, McMorland GH, Douglas MJ, Palmer L. Epidural morphine for analgesia after caesarean section: a report of 4880 patients. Can J Anaesth 1990;37:608–612.CrossRefGoogle Scholar
  104. 104.
    Ready LB, Loper KA, Nessly M, Wild L. Postoperative epidural morphine is safe on surgical wards. Anesthesiology 1991;75:452–456.PubMedCrossRefGoogle Scholar
  105. 105.
    Zimmermann DL, Steward J. Postoperative pain management and acute pain service activity in Canada. Can J Anaesth 1993;40:568–575.PubMedCrossRefGoogle Scholar
  106. 106.
    Rawal N, Wattwil M. Respiratory depression following epidural morphine: an experimental and clinical study. Anesth Analg 1984;63:8–14.PubMedGoogle Scholar
  107. 107.
    Breen TW, Janzen JA. Epidural fentanyl and caesarean section: when should fentanyl be given? Can J Anaesth 1992;39:317–322.PubMedCrossRefGoogle Scholar
  108. 108.
    Aguilar JL, Benhamou D, Bonnet F, et al. ESRA guide-lines for the use of epidural opioids. Int Monit Reg Anaesth 1997;9:3–8.Google Scholar
  109. 109.
    Romer HC, Russell GN. A survey of the practice of thoracic epidural analgesia in the United Kingdom. Anaesthesia 1998;53:1016–1022.PubMedCrossRefGoogle Scholar
  110. 110.
    Rawal N, Axelsson K, Hylander J, et al. Postoperative patient-controlled local anesthetic administration at home. Anesth Analg 1998;86:86–89.PubMedGoogle Scholar
  111. 111.
    Klein SM, Grant SA, Greengrass RA, et al. Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump. Anesth Analg 2000;91:1473–1478.PubMedCrossRefGoogle Scholar
  112. 112.
    Ilfeld BM, Morey TE, Wright TW, et al. Continuous interscalene brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebocontrolled study. Anesth Analg 2003;96:1089–1095.PubMedCrossRefGoogle Scholar
  113. 113.
    Ilfeld BM, Morey TE, Enneking FK. Continuous infraclavicular brachial plexus block for postoperative pain control at home. Anesthesiology 2002;96:1297–1304.PubMedCrossRefGoogle Scholar
  114. 114.
    Rawal N, Allvin R, Axelsson K, et al. Patient-controlled regional analgesia (PCRA) at home. Anesthesiology 2002;96:1290–1296.PubMedCrossRefGoogle Scholar
  115. 115.
    Ilfeld BM, Morey TE, Wang RD, Ennekin FK. Continuous popliteal sciatic nerve block for postoperative pain control at home. Anesthesiology 2002;97:959–965.PubMedCrossRefGoogle Scholar
  116. 116.
    Klein SM, Greengrass RA, Grant SA, et al. Ambulatory surgery for multi-ligament knee reconstruction with continuous dual catheter peripheral nerve blockade. Can J Anaesth 2001;48:375–378.PubMedCrossRefGoogle Scholar
  117. 117.
    Zaric D, Boysen K, Christiansen J, Haastrup U, Kofoel H, Rawal N. Continuous sciatic nerve block: a new method of analgesia at home after foot surgery — a randomised controlled trial. Acta Anaesthesiol Scand 2004;48:337–341.PubMedCrossRefGoogle Scholar
  118. 118.
    Chelley JE, Gebhard R, Coupe K, et al. Local anesthetic delivered via a femoral catheter by patient-controlled analgesia pump for pain relief after an anterior cruciate ligament outpatient procedure. Am J Anesthesiol 2001;28:192–194.Google Scholar
  119. 119.
    Ilfeld BM, Morey TE, Enneking FK. Outpatient use of patient-controlled local anesthetic administration via a psoas compartment catheter to improve pain control and patient satisfaction after ACL reconstruction. Anesthesiology 2001;95:A38.Google Scholar
  120. 120.
    Buckenmaier CC II, Kamal A, Rubin Y, et al. Paravertebral block with catheter for breast carcinoma surgery and continuous paravertebral infusion at home. Reg Anesth Pain Med 2002;27:A47.Google Scholar
  121. 121.
    Borgeat A, Ekatodramis G, Kalberer F, Benz C. Acute and non acute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology 2001;95:875–880.PubMedCrossRefGoogle Scholar
  122. 122.
    Tuominen MK, Pere P, Rosenburg PH. Unintentional arterial catheterization and bupivacaine toxicity associated with continuous interscalene brachial plexus block. Anesthesiology 1991;75:356–358.PubMedCrossRefGoogle Scholar
  123. 123.
    Cook LB. Unsuspected extradural catheterization in an interscalene block. Br J Anaesth 1991;67:473–475.PubMedCrossRefGoogle Scholar
  124. 124.
    Moss G, Regal ME, Lichtig L. Reducing postoperative pain, narcotics, and length of hospitalization. Surgery 1986;99:206–210.PubMedGoogle Scholar
  125. 125.
    McLoughlin J, Kelley CJ. Study of the effectiveness of bupivacaine infiltration of the ilioinguinal nerve at the time of hernia repair for postoperative pain relief. Br J Clin Pract 1989;8:281–283.Google Scholar
  126. 126.
    Owen H, Galloway DJ, Mitchell KG. Analgesia by wound infiltration after surgical excision of benign breast lumps. Ann R Coll Surg Engl 1985;67:114–115.PubMedGoogle Scholar
  127. 127.
    Patridge BL, Stabile BE. The effects of incisional bupivacaine on postoperative narcotic requirement, oxygen saturation and length of stay in the postoperative unit. Acta Anaesthesiol Scand 1990;34:486–491.CrossRefGoogle Scholar
  128. 128.
    Bourne MH, Johnson KA. Postoperative pain relief using local anesthetic instillation. Foot Ankle 1989;44:964–966.Google Scholar
  129. 129.
    Pryn SJ, Cross MM, Murison SC, et al. Postoperative analgesia for haemorrhoidectomy. Anaesthesia 1989;44:964–966.PubMedCrossRefGoogle Scholar
  130. 130.
    White PF, Rawal S, Latham P, et al. Use of a continuous local anesthetic infusion for pain management after median sternotomy. Anesthesiology 2003;99:918–923.PubMedCrossRefGoogle Scholar
  131. 131.
    Rawal N. Ambulatory wound and intra-articular infusions. In: Steele S, Nielsen KC, Klein SM, eds. Ambulatory Anesthesia and Perioperative Analgesia. New York: McGraw-Hill; 2005:503–517.Google Scholar
  132. 132.
    Nielsen KC, Steele S. Ambulatory evaluation and safety considerations. Tech Reg Anesth Pain Manage 2004;8:99–103.CrossRefGoogle Scholar
  133. 133.
    Cuvillon P, Ripart J, Lalourcey L. The continuous femoral nerve bock catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg 2001;93:1045–1049.PubMedCrossRefGoogle Scholar
  134. 134.
    Axelsson K, Nordensson U, Johanzon E, et al. Patient-controlled regional analgesia (PCRA) with ropivacaine after arthroscopic subacromial decompression. Acta Anaesthesiol Scand 2003;47:993–1000.PubMedCrossRefGoogle Scholar
  135. 135.
    Vintar N, Rawal N, Veselko M. Intraarticular patient-controlled regional anesthesia after arthroscopy assisted anterior cruciate ligament reconstruction: ropivacaine/morphine/ ketorolac versus ropivacaine/morphine. Anesth Analg 2005;101:573–578.PubMedCrossRefGoogle Scholar
  136. 136.
    Rosseland LA, Stubhaug A, Grevbo F, et al. Effective pain relief from intra-articular saline with or without morphine 2 mg in patients with moderate-to-severe pain after knee arthroscopy: a randomized, double-blind controlled clinical study. Acta Anaesthesiol Scand 2003;47:732–738.PubMedCrossRefGoogle Scholar
  137. 137.
    Park J-Y, Lee G-W, Kim Y, et al. The efficacy of continuous intra-bursal infusion with morphine and bupivacaine for postoperative analgesia after subacromial arthroscopy. Reg Anesth Pain Med 2002;27:145–149.PubMedGoogle Scholar
  138. 138.
    DeWess FT, Akbari Z, Carline E. Pain control after knee arthroplasty: intraarticular versus epidural anesthesia. Clin Orthop Relat Res 2001;392:226–231.CrossRefGoogle Scholar
  139. 139.
    Rasmussen S, Kramh M U, Sperling KP, Pedersen JHL. Increased flexion and reduced hospital stay with a continuous intraarticular morphine and ropivacaine after primary total knee replacement: open intervention study of efficacy and safety of 154 patients. Acta Orthop Scand 2004;75:606–609.PubMedCrossRefGoogle Scholar
  140. 140.
    Souron V, Reiland Y, De Traverse A. Interpleural migration of an interscalene catheter. Anesth Analg 2003;97:1200–1201.PubMedCrossRefGoogle Scholar
  141. 141.
    Cook LB. Unsuspected extradural catheterization in an interscalene block. Br J Anaesth 1991;67:473–475.PubMedCrossRefGoogle Scholar
  142. 142.
    Mathoudeau G, Gaertner E, Launoy A. Interscalenic block: accidental catheterization of the epidural space. Ann Fr Anesth Reanim 1995;14:438–441.Google Scholar
  143. 143.
    Xapdevila X, Macaire P, Aknin P, et al. Patient-controlled perineural analgesia after ambulatory orthopedic surgery: a comparison of electronic versus elastomeric pumps. Anesth Analg 2003;96(2):414–417.Google Scholar
  144. 144.
    Ilfeld B, Morey T, Kayser Enneking F. Portable infusion pumps used for continuous regional analgesia: delivery rate accuracy and consistency. Reg Anesth Pain Med 2003(5); 28:424–432.Google Scholar
  145. 145.
    Klein SM, Grant SA, Greengrass RA, et al. Interscalene brachial plexus block infusion pump. Anesth Analg 2000;91:1473–1478.PubMedCrossRefGoogle Scholar
  146. 146.
    Klein SM, Nielsen KC, Greengrass RA, Aarner DS, Martin A, Steele S. Ambulatory discharge after long-acting peripheral nerve blockade: 2382 blocks with ropivacaine. Anesth Analg 2002;94:65–90.PubMedGoogle Scholar
  147. 147.
    Shah S, Vloka JD, Hadzic A. The future of ambulatory surgery and regional anesthesia. In: Steele S, Nielsen KC, Klein SM, eds. Ambulatory Anesthesia and Perioperative Analgesia. New York: McGraw-Hill; 2005:553–559.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Narinder Rawal
    • 1
  1. 1.Department of Anesthesiology and Intensive CareUniversity HospitalÖrebroSweden

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