الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
In the recent past, suffering severe pain was accepted as an inevitable consequence of major orthopaedic surgery. Fortunately, through the diligent and creative efforts of many dedicated practitioners and researchers, this ‘fact of life’ is now avoidable.
The recent studies show that continuous peripheral nerve block (CPNB) with perineural catheter is considered as an optimal choice for analgesia after orthopaedic procedures and decrease the need for opioid-based analgesia avoiding its side effects, that allow patient early mobilization, decrease hospital stay, reduce unanticipated hospital readmission, and reduce health care costs. Also, recent advances in the use of ultrasound guidance to introduce perineural catheters for the performance of continuous nerve blocks allows the anaesthetist to reposition the needle in the event of misdistribution and monitoring the distribution of local aesthetic which decrease the failure rate and the complication of nerve injury.
Other promising methods of increasing the duration of postoperative pain control –but with variable success- is the use of adjuvants to extend the duration of single dose blocks (as, dexmedetomidine, magnesium, dexamethasone, midazolam, buprenorphine and tramadol) and the novel compounds local anaesthetics (Liposomal bupivacaine).
A lower incidence of adverse effects and improved analgesia has been demonstrated with multimodal analgesia techniques by combining different analgesics that act in synergistic way to control postoperative pain (as, dexamethosone, paracetamol, non-selective NSAID, coxibs, ketamine, magnesium, gabapentin, pregabalin and dexmedetomidine).
In conclusion it’s now evidence based that the continuous perineural catheter with ultrasound guidance combined with systemic multimodal analgesics represents the best combination of safety and efficacy to provide prolonged post orthopaedic surgery analgesia.