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KMID : 0948920020010010031
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Clinical Pain
2002 Volume.1 No. 1 p.31 ~ p.38
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Peripheral Nerve Blockade
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Kim Mi-Jung
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Abstract
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Significant medical advances of the past decades have influenced the manner of pain management, of which nerve blockade may be a very useful tool to relieve pain. In particular, peripheral nerve blockade (PEN) is a safe and effective method with cautious application compared to central nerve blockade or opioids use. The main prerequisite for successful PEN is a full understanding of the relevant anatomy of the target nerves and intervening structures, pharmacology of local anesthetics, meticulous technique, clinical experience, and active cooperation of patients. Contraindications to PEN are few and most are only relative, such as, infection or trauma over the site of the proposed block, coagulopathy or full anticoagulation, patient refusal despite full discussions, or intractable metabolic derangement. Equipments for PEN are general anesthesia and resuscitation set, local anesthetic drugs, peripheral nerve stimulator, and sterile set including needles and syringes. Complications of PEN are related to technique, patient factors, and local anesthetics. However, most complications can be prevented by attention to detail in assessing patient, planning and performing the block, and in monitoring the patient closely during and after PEN. The commonly used sites of PEN are the stellate ganglion, peripheral nerves of the upper limb, and less likely, peripheral nerves of lower limb. The exact action mechanism of the PEN is not thouroughly understood, but PEN may be very powerful in managing patients with pain. Further research and clinical study is needed to document the action mechanism of PEN and to optimize various medical and technical debates of PEN.
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KEYWORD
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Pain, Peripheral nerve blockade, Local anesthetics
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