Peripheral nerve blocks as part of a multimodal analgesia approach in orthopaedic patients
Abstract
Local anaesthetic nerve blocks are an effective and often underused method of providing analgesia for orthopaedic patients. Local anaesthetics are the only drug capable of completely blocking all pain perception and with duration of action of up to 6 hours for some drugs, they are able to provide pain relief far into the post-operative recovery period. By using local anaesthetic blocks as part of a preemptive multimodal analgesia protocol concurrent systemic analgesic drug doses may be able to be decreased, reducing side effects for the patient. The desired outcome is a comfortable patient that has a faster return to normal function and a shorter hospitalized period.
Orthopaedic surgery is routinely performed in many first opinion and specialized referral clinics and are among the most painful and complex surgeries that are performed. Complex fracture repair will cause a high degree of noxious (harmful) surgical stimulation that the patient may react to under anaesthesia and into the post-surgical period. Less invasive procedures such as arthroscopy may result in less marked surgical stimulation, but it is important that the analgesia protocols used for orthopaedic patients are appropriate for the severity and duration of the stimulation, resulting tissue damage and pain perception experienced by each individual animal.
The use of the combination of two or more analgesic drugs to prevent and treat pain sensation at different points in the pain pathway is known as multi-modal analgesia. By combining drugs such as opioids, non-steroidal anti-inflammatory drugs (NSAIDs), local anaesthetics, alpha 2 (α2) agonists and N-methyl-D-aspartate (NMDA) antagonists, more effective analgesia can be provided for the patient than by using a single analgesic drug.
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