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barrier precautions for central venous catheter placement (cap, mask, sterile gown and gloves;
and large drape). Specific trial data for aseptic technique in CPNB is lacking, however in a
review of infections associated with CPNB as reported in 12 case series, Capdevila et al
(Capdevila et al, 2009 Level IV) supported the use of full surgical‐type aseptic technique for
CPNB procedures.
Identified risk factors for local CPNB catheter inflammation include intensive care unit stay,
duration of catheter use greater than 48 hours, lack of antibiotic prophylaxis, axillary or
femoral location and frequent dressing changes (Capdevila et al, 2009 Level IV). The implications
of catheter‐related sepsis in patients with implanted prosthetic devices (eg joint arthroplasty)
are significant and therefore all reasonable measures should be taken to minimise this risk.

Key messages
1. Topical EMLA® cream (eutectic mixture of lignocaine [lidocaine] and prilocaine) is effective
in reducing the pain associated with venous ulcer debridement (U) (Level I [Cochrane
Review]).
2. Compared with opioid analgesia, continuous peripheral nerve blockade (regardless of
catheter location) provides better postoperative analgesia and leads to reductions in
opioid use as well as nausea, vomiting, pruritus and sedation (N) (Level I).
3. Femoral nerve block provides better analgesia compared with parenteral opioid‐based
techniques after total knee arthroplasty (S) (Level I).
4. Compared with thoracic epidural analgesia, continuous thoracic paravertebral analgesia
results in comparable analgesia but has a better side effect profile (less urinary retention,
hypotension, nausea, and vomiting) than epidural analgesia and leads to a lower incidence
of postoperative pulmonary complications (N) (Level I).
5. Blocks performed using ultrasound guidance are more likely to be successful, faster to
perform, with faster onset and longer duration compared with localisation using a
peripheral nerve stimulator (N) (Level I). CHAPTER 7
6. Morphine injected into the intra‐articular space following knee arthroscopy does not
improve analgesia compared with placebo (R) (Level I).
7. Intra‐articular local anaesthetics reduce postoperative pain to a limited extent only (U)
(Level I).

8. Continuous local anaesthetic wound infusions lead to reductions in pain scores (at rest and
with activity), opioid consumption, postoperative nausea and vomiting, and length of
hospital stay; patient satisfaction is higher and there is no difference in the incidence of
wound infections (S) (Level I).
9. Intraperitonal local anaesthetic after laparoscopic cholecystectomy improves early
postoperative pain relief (N) (Level I).
10. Intraurethral instillation of lignocaine gel provides analgesia during flexible cystoscopy (N)
(Level I).

11. Continuous interscalene analgesia provides better analgesia, reduced opioid‐related side
effects and improved patient satisfaction compared with IV PCA after open shoulder
surgery (U) (Level II).
12. Continuous femoral nerve blockade provides postoperative analgesia that is as effective as
epidural analgesia but with fewer side effects following total knee joint replacement
surgery (U) (Level II).
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