POSTOPERATIVE LOCOREGIONAL ANALGESIA IN ADULTS - EPIDURAL, SPINAL ANDPERIPHERAL TECHNIQUES, INDICATIONS, ADVERSE-EFFECTS AND MONITORING

Regional analgesia is a very effective way to treat postoperative pain . Lumbar and thoracic epidural analgesia are well adapted to major abd ominal and thoracic surgery. Nevertheless, respiratory side effects in duced by opioids are potentially severe and an adequate monitoring is essential. In orthopaedic surgery, perineural blocks are the best tech nique to manage postoperative pain and perineural catheters may be use d. The importance of intra-articular analgesia, simple and safe, is no t fully understood. The association of a local anaesthetic inducing a minor motor block and a strong sensitive block (bupivacaine, ropivacai ne), with an opioid seems to be the best pharmacologic choice regardin g quality of analgesia and safety. Benefits of postoperative regional analgesia on mortality and morbidity are not demonstrated. Medical and nursing staff and specialized units should improve quality of postope rative regional analgesia as well. General guidelines for the practice of regional anaesthesia must be closely followed. (C) 1998 Elsevier, Paris.