Peri-operative Prolonged Analgesia

It was proposed that preemptive analgesia may play an important role in a holistic strategy to improve an outcome of orthopedic procedures. This is true for both acute and chronic post-operative pain.
During the last couple of years, we performed roughly 150 procedures with preemptive initiation of regional analgesia (both as a sole regional anesthetic technique or as a part of combined general / regional anesthesia). This requires a special set-up, starting with availability of highly trained anesthesiologists, availability of US devices and close follow up by the nursing staff including pain assessment and secured mobilization.
Pre-operative assessment of risk factors for pre-existing pain syndromes is imperative.

Patient records between the years 2014-2016 were reviewed. Inclusion criteria were: bony or combined procedures, age over 18, use of regional anesthesia (with or without general anesthesia). Exclusion criteria were: pre-existing neuropathies, pre-existing infections. Records were reviewed for post-operative infection rates, 1-year mortality, new use of tricyclic antidepressants, pregabalin, gabapentin or other treatment for neuropathic pain.

5 patients needed medication for neuropathic pain. No patients developed CRPS. Rates of post-operative infections did not increase.

Initiation of a routine use of regional analgesia demands capital investment and could be demanding in respect of materials, preparation and patient follow-up. Nevertheless, this technique is rewarding in regards to patient comfort. We highly recommend this technique for ambulatory procedures.