Physiologic Advantages of Peripheral Nerve Blockade Translate to Decreased Length of Stay and Improved Patient Satisfaction.
Tissue damage resulting from traumatic injury or surgical procedures activates signaling cascades that lead to the transmission of pain signals. Avoidance of pain-related morbidities is necessary for recovery and rehabilitation after surgery or traumatic insult. Aside from unnecessary patient suffering, inadequate pain control results in unchecked sympathetic outflow, which has detrimental multi-systemic physiologic sequelae.
In the cardiovascular system, poorly managed pain results in hypertension and tachycardia, increasing myocardial oxygen demand and placing the patient at risk for cardiac ischemia or myocardial infarction. Elsewhere, vasoconstriction decreases flow to the surgical site, increasing risk of surgical site infection.
In the limbs, vasoconstriction leads to venous stasis, increasing the risk for thromboembolic events. The sympathetic response can also lead to urinary retention, respiratory compromise, catabolic stress, inflammation, immunosuppression, sleep disturbance, and postoperative ileus.
These comorbidities can prolong hospital stay and increase health care expenditures. Adequate pain control helps facilitate recovery. Preventing pain related comorbidities allows for early ambulation, faster return to bowel motility, and increased patient satisfaction. Pain control regimens can have adverse effects of their own.
Opioid therapy, the historical mainstay of pain management, can result in respiratory depression, nausea, constipation,
postoperative ileus, and pruritus. While opioids are effective analgesics, their use as a sole analgesic may lead to adverse events, further complicating recovery and prolonging length of hospital stay.
Res Pract Anesthesiol Open J. 2016; 1(1): 4-14. doi: 10.17140/RPAOJ-1-103
