Peripheral regional techniques for acute pain treatment

Peripheral regional blocks are an attractive option for providing analgesia after surgery or trauma. The techniques have gained popularity, as the development of more suitable catheters and pumps has permitted the widespread use of continuous techniques, even in an outpatient setting. They have become safer following the development of enantiomer specific local anaesthetics, such as ropivacaine, for which the pharmacokinetics of continuous infusion are well established. Often they are superior to systemic analgesia techniques, because they provide excellent pain relief, in particular during mobilization and physiotherapy, without the systemic adverse effects linked to intake of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids. In particular, after orthopaedic surgery to the lower limbs, they may be superior to epidural analgesia and are not associated with its rare, but potentially catastrophic, complications. Despite these advantages, the techniques are not used to their full potential in many settings. Further promotion of their usefulness and better training of anaesthetists in their use is necessary.