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Regional anesthesia
The document discusses regional anesthesia, emphasizing its applications in specific surgeries and the types of blocks, including neuraxial and peripheral nerve blocks. It outlines indications and contraindications for each method, highlighting drugs used and potential complications associated with them. Overall, it serves as a guide for the use of regional anesthesia in various surgical contexts.
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Regional anesthesia
- 1. BY DR. MUHAMMAD SAIFULLAH HOUSEOFFICER ANESTHESIA AND ICU DEPARTMENT ALLIED HOSPITAL, FAISALABAD
- 3. Regional anesthesia isanesthesia affecting only a specific area of the body when the patient is conscious, e.g. foot, arm, lower extremities, insensate to stimulus of surgery or other instrumentation.
- 4. REGIONAL ANESTHESIA CENTRAL (NEURAXIAL) BLOCKS SPINAL ANESTHESI A EPIDURAL ANESTHESIA COMBINE DSPINAL & EPIDURAL (CSE) CAUDAL BLOCK INTRAVENOUS REGIONAL ANESTHESIA PERIPHERAL NERVE BLOCKS PLEXUS BLOCK ULTRASOUND GUIDED NERVE STIMULATION SINGLE NERVE BLOCK
- 5. Spinal, epidural,and caudal blocks are also known as neuraxial anesthesia. Almost all operations below the neck can be performed under neuraxial anesthesia. However, because intrathoracic, upper abdominal, and laparoscopic operations can significantly impair ventilation, general anesthesia with endotracheal intubation is also necessary.
- 8. Uses / Indications lower abdominal surgery inguinal surgery urogenital surgery rectal surgery lower extremity surgery Lumbar spinal surgery Obstetrical – C/Section Contra-indications Absolute Severe hypovolemia Increased ICP Infection at injection site Patient refusal Coagulopathy Severe AS or MS Relative Severe spinal deformity Sepsis Uncooperative patient Preexisting neurological deficits Demyelinating lesions Stenotic valvular heart lesions
- 9. Bupivacaine Tetracaine Procaine Bupivacaine (0.75% in 8.25% Dextrose) 4-10 mg 12-14 mg 12-18 mg 90-120 min Complicatons High/Total spinal Hypotension due to sympathetic block Post dural puncture headache Bleeding Transient Neurological Syndrome
- 10. Indications Hip andKnee Surgery Lower Extremity Vascular Surgery Lower Extremity Amputation Obstetrical – Labor & C/S Thoracic Surgery – Post-Op Pain Control Thoracic Trauma Abdominal Surgery – Post-Op Pain Control Contraindications Patient refusal for surgery Uncooperative patients Coagulopthy Skin infection at injection site Hypovolaemia Presence of neurological disorders cardiovascular disease Kyphoscoliosis
- 12. Chloroprocaine (Fast) Lidocaine (Intermediate) Mepivacaine (Intermediate) Bupivacaine (Slow) Ropivacaine (Slow) Complications Accidental Dural Puncture High Epidural Local Anesthetic Toxicity Total Spinal
- 13. Suitable whenevera rapid onset of analgesia is required but the period of analgesia required exceeds that of a single spinal injection. Post operative pain relief In labouring women, the onset of analgesia is more rapid with CSE Contraindications, drugs dosages & adverse effects are the same as spinal and epidural anesthesia.
- 14. Indications Pediatric anesthesia Anorectal surgery in adults Lower extrimity surgery A dosage of 0.5–1.0 mL/kg of 0.125–0.25% bupivacaine (or ropivacaine) with or without epinephrine can be used Given usually after induction of GA for Intra- operative supplementation and post operative analgesia.
- 16. Indications Surgery ata specific extremity lower back pain neck pain sciatica (from a herniated disc) spinal stenosis reflex sympathetic dystrophy (a complex regional pain syndrome) shingles cancer painful peripheral vascular disease treatment of migraine headache Contraindications Uncooperative patient Bleeding diathesis Infection Local anesthetic toxicity Peripheral neuropathy
- 17. Somatic Blockadeof the Upper Extremity Somatic Blockade of the Lower Extremity Somatic Blockade of the Trunk
- 18. Indications Distal Armor Leg Surgery Useful for Short Procedures Contra-Indications Raynaud’s Disease Sickle Cell Disease Crush Injury to the Limb Very Young may need additional Injection of local anesthetic intravenously for anesthesia of an extremity Advantages: technically simple, minimal equipment, rapid onset Disadvantages: duration limited by tolerance of tourniquet pain, toxicity