Safety and quality aspects of regional anesthesia

The aim of this thesis was to investigate safety, efficacy and training aspects of currently employed regional anesthesia (RA) techniques, and also to compare different clinically used methods with each other.
Firstly, we provide an overview of developments in the field of RA. We continue with a systematic review of the literature, on patient-controlled versus continuous epidural analgesia. We explore which of the two application modes is safer and has less disadvantages in patients undergoing non-obstetric surgery. We explored other aspects of epidural analgesia, comparing the number of top-ups and side-effects during the postoperative use of patient-controlled or continuous epidural analgesia (PCEA). We analyzed the postoperative treatment of pain in patients with fractures of the calcaneus and talus, comparing continuous nerve blocks to intravenous patient- controlled analgesia. Further, we compare two different blocks in the postoperative treatment of displaced calcaneal fractures: a popliteal block by the anesthesiologist and an ankle block by the surgeon. We investigated safety aspects of the continuous wound catheter technique, comparing bupivacaine plasma levels during bolus injection through pre-peritoneal wound catheters versus epidural catheters. We describe the face and construct validity of the TU-Delft epidural simulator, and advantages of real-time visualization using MRI modeling in teaching residents. Lastly, we describe the results of bacterial culture and scanning electron microscopy of epidural catheters.