Canadian Journal of Anesthesia 53:967 (2006)
© Canadian Anesthesiologists' Society, 2006
Mayo Clinic analgesic pathway: peripheral nerve blockade for major orthopedic surgery
Robert L. Lennon, Terese T. Horlocker (Eds). Mayo Clinic Scientific Press (Rochester, Minnesota, 2006). Cost: $93.50 (CDN, through Chapters). 137 pages. ISBN 0849395720
Holly Evans, MD FRCP(C)
The Ottawa Hospital, Ottawa, Canada
This manuscript presents a comprehensive, multimodal analgesic pathway for total hip and knee arthroplasty. Protocols are presented in which single injection and continuous peripheral nerve blocks of the lower extremity are used for postoperative analgesia and supplemented with both opioid and non-opioid oral analgesics. While not intended to be a comprehensive text on peripheral nerve blockade, the manuscript outlines the different approaches to both lumbar plexus and sciatic nerve blocks and includes guidelines on the clinical application of each approach. A review of applied anatomy and nerve block technique is provided and reinforced with original, clearly-labelled, colour figures. Specific considerations are outlined for the perioperative management of patients with arthritis, those prescribed thromboprophylaxis and those receiving continuous in-hospital or ambulatory perineural local anesthetic infusions. Analgesic protocols were developed by a multidisciplinary team consisting of anesthesiologists, surgeons, nurses, physiotherapists and pharmacists whose aim was to provide superlative postoperative analgesia, enhanced patient recovery and timely discharge. This protocol has enabled 95% of Mayo Clinic patients having total knee arthroplasty and 80% of patients having total hip arthroplasty to be discharged home within 48 hr. The approach to postoperative analgesia outlined in this manuscript deserves consideration, particularly in this era of bed shortages and fiscal restraint.
