Page 32 Acute Pain Management

Other regional and local analgesic techniques
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
SUMMARY 4. Compared with thoracic epidural analgesia, continuous thoracic paravertebral analgesia
techniques after total knee arthroplasty (S) (Level I).

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

Blocks performed using ultrasound guidance are more likely to be successful, faster to
5. incidence of postoperative pulmonary complications (N) (Level I).
perform, with faster onset and longer duration compared with localisation using a
peripheral nerve stimulator (N) (Level I).
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).
13. Continuous posterior lumbar plexus analgesia is as effective as continuous femoral
analgesia following total knee joint replacement surgery (U) (Level II).
14. Intra‐articular bupivacaine infusions have been associated with chondrolysis and their
use has been cautioned against (N) (Level IV).

xxxii Acute Pain Management: Scientific Evidence