Incisional and intra-articular infusions

Incisional and intra-articular local anaesthetic techniques are simple, safe and inexpensive analgesic methods for the management of post-operative pain following a variety of surgical procedures. These techniques are capable of providing effective analgesia over a limited field and with minimal systemic effects. In the literature single-dose local anaesthetics have been administered in most of the studies; however, the duration of analgesia is short-lived. In recent years catheter techniques have been increasingly used as intermittent bolus or continuous infusion in the surgical wound or intra-articularly for long-lasting post-operative analgesia in both hospitalized and day-case patients. The incisional and intra-articular use of opioids and several non-opioids, either alone or in combination with local anaesthetics, has also been evaluated. This chapter reviews the current status of single dose and infusions of local anaesthetics and adjuvants for incisional and intra-articular analgesic techniques and also looks at future perspectives.