Continuous Peripheral Nerve Blocks

Edward R. Mariano, M.D., M.A.S. (Clinical Research)
Associate Clinical Professor
Chief, Division of Regional Anesthesia and Acute Pain Medicine
Department of Anesthesiology
University of California, San Diego Medical Center
San Diego, California

Introduction - TOP

Continuous peripheral nerve block (CPNB) techniques provide target-specific analgesia for a variety of surgeries.1-5  Compared to single-injection nerve block techniques, CPNB involves the percutaneous insertion of an indwelling catheter in the proximity of a target nerve (also known as a perineural catheter) that acts as a conduit for a continuous local anesthetic infusion.  The use of CPNB facilitates same-day discharge after many types of extremity surgery which would have required at least overnight admission for pain control only a few years ago.  Even for patients who undergo knee or shoulder replacement surgery, CPNB analgesia decreases the time to achieve discharge criteria and may be continued outside of the hospital setting for patients eligible for ambulatory recovery.4,6

Placement methods for perineural catheters vary based on the nerve localization technique (electrical nerve stimulation versus ultrasound-guidance) and the specific type of equipment involved.  CPNB procedures should be performed employing sterile technique in a location where standard noninvasive hemodynamic monitoring and an oxygen source are available.  Intravenous sedation should be administered to ensure patient comfort when necessary in this monitored setting.  While it is impossible to present all available placement techniques in one article, the following descriptions will serve as an overview and highlight the major differences between commonly-performed approaches.  Please refer to the other sections of the website to review the surface anatomic landmarks and sonoanatomy for each nerve block location. 

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