Chapter 10: Pain assessment and management
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Pre‐procedural considerations
Equipment
CPNB catheters are inserted using a hollow Tuohy‐type needle connected to a nerve stimulator or an ultrasound that identifies the nerve and allows the correct placement of the catheter (D'Arcy [45], Parizkova and George [137], [138]). Once correct placement has been confirmed, the catheter is threaded down the hollow centre of the needle to the area that needs analgesia. All products should now be NRFit compatible, following a nationwide conversion from the Luer connector to NRFit for intrathecal procedures, epidural procedures and delivery of regional blocks in accordance with NPSA ([133]). For more information, see the section on clinical governance within the section below on epidural analgesia.
Dressings
The dressing over the CPNB catheter exit site needs to fulfil the following three functions:
- help to secure the CPNB catheter
- minimize the risk of infection
- allow observation of the site without disturbing the dressing.
A transparent moisture‐responsive occlusive dressing (e.g. Tegaderm, OPSITE or IV3000) fulfils these functions. The CPNB catheter site should be inspected daily.
Pharmacological support
In CPNBs, local anaesthetic infusions are used. Rarely are other drugs combined with this approach.
Procedure guideline 10.2