The insiders' experiences with continuous transversus abdominis plane blocks for analgesia after cesarean delivery.

OBJECTIVE: Transversus abdominis plane blocks have been recently utilized for analgesia after cesarean delivery. However, little data concerning continuous transversus abdominis plane blocks has been reported in the existing literature. Available studies mainly examine the efficacy of single-injection blocks, and only one small case series has been published regarding continuous blocks for analgesia after cesarean delivery. First-hand experiences and observations of three acute pain medicine specialists who received a continuous transversus abdominis plane block for analgesia after cesarean delivery are presented. SETTINGS AND PATIENTS: Three physicians specialized in acute and perioperative pain medicine personally underwent continuous transversus abdominis plane block placements for analgesia after cesarean delivery via a disposable infusion pump at the same teaching hospital. RESULTS: In a very motivated, well-supported, and informed patient after uncomplicated cesarean delivery, the use of continuous transversus abdominis plane blocks for analgesia offers the significant advantages of early functional recovery and excellent prolonged analgesia. CONCLUSION: The patients experienced postoperative continuous transversus abdominis plane blocks that seem to be of value in limiting opiate use and improving analgesia with daily activities in the acute postoperative phase after cesarean delivery.

Did continuous femoral and sciatic nerve block obscure the diagnosis or delay the treatment of acute lower leg compartment syndrome? A case report.

OBJECTIVE: We report a case of acute lower extremity compartment syndrome that was diagnosed despite continuous regional analgesia with 0.2% ropivacaine via femoral and sciatic nerve catheters. SETTING: Academic tertiary care center. STUDY DESIGN: Report of a clinical case. SUMMARY: A 15-year-old boy with adolescent Blount's disease underwent elective distal femur and proximal tibia osteotomy with external fixation and stabilization of his right leg. The patient's anesthetic and analgesic management included general anesthesia with adjunctive regional anesthesia via continuous femoral and sciatic nerve blocks with 0.2% ropivacaine-each block initially infused at 10 mL per hour. On the first postoperative day, the patient reported no pain (0/10 on the visual analog scale, where 0 is no pain and 10 is the worst pain imaginable). However, on the second postoperative day, the patient reported severe pain despite effective blocks and oral opioid analgesic modalities. Compartment syndrome was diagnosed and treated with decompressive fasciotomy; tissue loss resulted. CONCLUSION: Despite concerns of masking pain that may be secondary to compartment syndrome, this case demonstrates that compartment syndrome can be diagnosed in the presence of effective regional anesthesia. Careful clinical evaluation coupled with a high index of suspicion is essential in the timely diagnosis and effective treatment of compartment syndrome.