الفهرس 
Local AnestheticsOnly 14 pages are availabe for public view
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Abstract
Summary
Management of postoperative pain relieves suffering
and leads to earlier mobilization, shortened hospital stay,
reduced hospital costs, and increased patient satisfaction. Pain
control regimens should not be standardized; rather, they are
tailored to the needs of the individual patient, taking into
account medical, psychological, and physical condition; age;
level of fear or anxiety; surgical procedure; personal
preference; and response to agents given.
Nociception is the physiologic process of activation of
neural pathways by stimuli that are potentially or currently
damaging to tissue. Pain in contrast to nociception, is a
conscious experience.
Local anesthetics are drugs used to prevent or relieve
pain in specific regions of the body. Currently used local
anesthetics bind to voltage-gated Na+ channels in peripheral
nerves, block sodium movement through sodium channel, and
thus block nerve conduction.
Local anesthetics may be toxic if sufficient amounts are
absorbed into the systemic circulation. Of these bupivacaine
appears to be the most dangerous although all can be harmful.
Clinical toxicity appears to relate to the effects of the drug on
other excitable membranes in the CNS and cardiovascular
systems.
Effective analgesia is an essential part of postoperative
management. Many regional analgesic techniques can be
applied for postoperative pain control as neuroaxial analgesia,
peripheral nerve block, truncal blockade and other techniques.
Intraoperative administration of epidural or intrathecal
opioids for example reduces the need for systemic opioids
postoperatively. For major abdominal surgeries with extensive
incisions, epidural infusions with local anesthetic provide
superior pain relief as compared with conventional parenteral
narcotics.
On the other hand, Peripheral nerve blocks (PNB) are
widely-used for both postoperative and nonsurgical
analgesia.The most common rationales for their use are to
avoid side effects and complications of general anesthesia
(GA), particularly respiratory-related effects, and to provide
analgesia while minimizing opioid use.
Similar to peripheral nerve blocks of the upper or lower
limb, truncal blocks provide excellent postoperative pain
relief, avoid the risk for major complications associated with
central nerve blockade such as epidural hematoma or abscess,
and can be used as a sole anesthetic technique for some types
of surgery. However, their use in daily practice has remained
limited until recently.
Lastly, many promising simple techniques might help
improve postoperative analgesia as: direct wound infiltration,
intra-articular injection.