Continuous techniques of nerve conduction blockade

Post-operative pain is a major concern after orthopaedic limb surgery. It not only causes the patient discomfort but also compromises early physical therapy, which is the most influential factor for post-operative rehabilitation and ambulation. Post-operative pain relief can be achieved by a number of techniques, such as parenteral opioids or central neural blockade. However, intra-venous patient controlled analgesia (PCA) with morphine does not provide efficient analgesia on movement and induces side effects such as nausea/vomiting or sedation. Epidural analgesia is more effective in relieving pain on movement, but is associated with catheter-related problems and a high incidence of side effects such as urinary retention or arterial hypotension. This chapter demonstrates that, because of an improved efficacy:side effects ratio, continuous peripheral nerve (interscalene or axillary brachial plexus, ‘3-in-1’, fascia iliaca, psoas compartment, sciatic) blocks are the most appropriate analgesic techniques available after orthopaedic limb surgery.