Peripheral nerve blocks for regional anesthesia in the lower extremity

Bang, Seung Uk

Review

Regional Anesthesia

Anesthesia and Pain Medicine 2014;9(4):237-249.
Published online October 31, 2014.

Peripheral nerve blocks for regional anesthesia in the lower extremity

Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Daejeon, Korea. seungukb@naver.com

Received: 14 July 2014 • Revised: 21 August 2014 • Accepted: 21 August 2014

Abstract

Historically, peripheral nerve blocks (PNBs) have not been as widely used as spinal and epidural anesthesia in the lower extremities due to difficulties inherent to the technique, resulting in an incomplete block and other complications. Recently, ultrasound machines have been used to facilitate locating peripheral nerves, resulting in a gradual increase in the utilization of PNBs. Currently, PNBs are used in sole regional anesthesia as well as for management of acute and chronic pain. PNBs have several advantages over other anesthetic techniques, such as central neuraxial blocks and general anesthesia. First of all, PNBs provide an improved peri-operative analgesia. Therefore, excessive opioid consumption is no longer necessary to control pain, and this results in fewer adverse effects, such as nausea, vomiting, pruritus, and respiratory depression. Furthermore, PNBs can be used as an alternative technique for high risk patients to whom a sympathetic blockade may lead to problems due to its little effect on hemodynamics. However, the use of PNBs also has pitfalls, such as a late onset, long preparation time, and risk of failure. There are advantages and disadvantages to using PNBs. If used on select cases with proper consideration for patient safety and satisfaction, PNBs can become commonly used, like other anesthetic techniques.

Key Words: Anesthesia, Lower extremity, Nerve block, Ultrasonography