A continuous peripheral nerve block (CPNB) consists of a percutaneously inserted catheter with its tip adjacent to a target nerve/plexus through which local anesthetic may be administered (by infusion or intermittent boluses), providing a prolonged block that may be titrated to the desired effect. It has proven to be a very effective strategy in postoperative pain management.We present two cases showing their benefits on inpatients on a Surgical Ward.
Tympanomastoidectomy with facial nerve monitoring usually impairs muscle relaxants' use. Airway hyperresponsiveness is common while manipula;ng a smoker's airway, par;cularly during endotracheal intuba;on. (1) Increasing the depth of anesthesia as well as blun;ng airway reflexes may be useful in these cases. (1)
CASE REPORTThe potent reflex to airway's s;mula;on can be aDenuated by upper airway nerve blocks. (2) The described blocks are usually performed in awake/anesthe;zed laryngoscopy, awake fiberop;c bronchoscopy and as an adjuvant to general anesthesia to facilitate intuba;on without muscle relaxant. (2) They aDenuate catecholamine release and hemodynamic response to airway's manipula;on, with lower incidence of cough and bulking, providing significant analgesia. (2) Aspira;on is not a concern because swallowing reflex is preserved. (2) Upper airway blocks are useful in laryngoscopy, awake fiberop;c bronchoscopy and intuba;on without muscle relaxa;on and should be performed by skilled professionals.
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