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FDA approval of Pacira Pharmaceuticals' (PCRX) Exparel as a brachial plexus block "is something of a watershed" in that the agency has never before approved any local or regional anesthetic for a single, specific setting, Piper Jaffray analyst David Amsellem tells investors in a research note.
The interscalene brachial plexus block is considered the optimal regional anesthetic technique for postoperative analgesia in healthy patients after shoulder surgery.
When used alone, regional anesthetic techniques do not involve endotracheal intubation, which prevents airway trauma, myalgia, and complaints such as postoperative nausea and vomiting.
As educators and patient advocates, nurses embrace a holistic approach to addressing pain, including nonopioid therapy alternatives, such as rehabilitative therapy, regional anesthetic interventions, surgery, psychological therapies, and complementary and alternative medicine.
Consequently, with no effect of regional anesthetic techniques known to promote the growth of tumor or metastases, it appears that these techniques should be widely employed whenever possible.
Although the current proposal does not intend to compare the efficacy of this procedure with others, it does support that it is possible to systematize a minimally invasive method in the surgical procedure of a peripheral nerve under the keyhole principle, using ambulatory criteria and with the least possible morbidity involved in the regional anesthetic procedure, with good tolerance and comfort for the patient during the operation and in the immediate postoperative period.
Historically, systemic administration of opioid drug groups has been the cornerstone of acute postoperative pain control but trends have changed towards increased utilization of regional anesthetic and analgesic techniques during the last few decades.
One of the greatest advances in pain control during GWOT was the introduction and management of advanced regional anesthetic techniques, specifically, continuous peripheral nerve block (CPNB) catheters and infusions.
"For example, 'keyhole' surgery, which is carried out through much smaller incisions, may be a possible stand-in for open surgery, while a regional anesthetic leaves you conscious, and can help you avoid the risks that come with general anesthesia."
The principal advantages of epidural anesthesia are lower risk for post dural puncture headache, less systemic hypotension, the ability to produce a segmental sensory block, skeletal muscle relaxation and contraction of the gastrointestinal tract are also produced by a regional anesthetic. Disadvantages of this anesthetic technique include the occasional failure and hypotension.

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