Indications for Continuous Nerve Block

A continuous peripheral nerve block is carried out with a percutaneously inserted catheter, targeting a certain nerve/plexus, through which a local anesthetic is administered to provide a prolonged block that can be precisely titrated. Given its safety and efficacy as a procedure, the indications for a continuous nerve block have grown over time, broadening its scope of clinical applicability.

Traditionally, continuous nerve block techniques have been used to control pain in patients undergoing major upper or lower extremity surgery. In addition, continuous nerve blocks have been classically used for the treatment of chronic pain such as resulting from cancer, a phantom limb, or complex regional pain syndrome.

Today, however, the indications for a continuous nerve block for perioperative pain management in hospitalized and ambulatory patients have extended well beyond the original, largely orthopedic contexts [1]. Over the past twelve years, continuous nerve blocks have grown popular for acute postoperative pain management following major thoracic surgery, for both inpatients and outpatients, in both children and adults, especially as part of a multimodal approach to postoperative pain treatment. A continuous nerve block can also provide perioperative analgesia in patients undergoing abdominal, plastic, urological, and gynecological surgeries.

Infusion regimens of local anesthetics and adjuvants must take into consideration a patient’s particular condition prior to and following the surgery, the intensity and nature of the surgical stress resulting from the surgery, and the possible need for immediate functional recovery [1].

A continuous nerve block has proven safe and effective in reducing opioid consumption and related side-effects, accelerating recovery, and, in many patients, reducing the length of hospital stay. A continuous nerve block also provides a safer alternative to epidural analgesia in patients receiving thromboprophylaxis, in particular with low molecular-weight heparin 1. Furthermore, it has been well established that a continuous nerve block decreases baseline/dynamic pain, reduces additional analgesic requirements, decreases postoperative joint inflammation and inflammatory markers [2]. It also helps minimize sleep disturbances and opioid-related side effects, increase patient satisfaction and boost ambulation/functioning. Finally, a continuous nerve block can lead to an accelerated resumption of passive joint range-of-motion, reduce time until discharge, decrease blood loss, reduce costs, and reduce the incidence of postsurgical chronic pain [2].

There are a number of specific indications and advantages to a continuous nerve block in pediatric clinical cases as well [3]. In children, data revealed that an outpatient continuous peripheral nerve block reduces the need for parenteral administration of opioid analgesics. Importantly, this technique can also be used in pediatric patients in home conditions. It is possible to discharge a patient home with catheter, but it is necessary to provide adequate education to patients, their parents, and staff, as well as to have a dedicated anesthesiology team [3].

Ongoing research is required to confirm and elaborate on the benefits of and indications for continuous nerve blocks in order to best ensure patient well-being across clinical contexts.



1. Chelly, J. E., Ghisi, D. & Fanelli, A. Continuous peripheral nerve blocks in acute pain management. Br. J. Anaesth. (2010). doi:10.1093/bja/aeq322

2. Aguirre, J., Del Moral, A., Cobo, I., Borgeat, A. & Blumenthal, S. The role of continuous peripheral nerve blocks. Anesthesiology Research and Practice (2012). doi:10.1155/2012/560879

3. Simić, D. et al. The safety and efficacy of the continuous peripheral nerve block in postoperative analgesia of pediatric patients. Frontiers in Medicine (2018). doi:10.3389/fmed.2018.00057