University:
Michigan State University
Course:
ANES 621 | Concepts in Clinical Anesthesiology I (Interim New)
Academic year:

2021
Views:

40

Pages:

19
Author:

omiliar74be

REGIONAL ANESTHESIA Regional anesthesia - Definition Rendering a specific area of the body, e.g. foot, arm, lower extremities, insensate to stimulus of surgery or other instrumentation Regional anesthesia - Uses ● ● ● Provide anesthesia for a surgical procedure Provide analgesia post-operatively or during labor and delivery Diagnosis or therapy for patients with chronic pain syndromes Regional anesthesia - types ● ● ● ● ● ● Topical Local/Field Intravenous block (“Bier” block) Peripheral (named) nerve, e.g. radial n. Plexus - brachial, lumbar Central neuraxial - epidural, spinal Topical Anesthesia ● ● ● ● ● ● ● ● Application of local anesthetic to mucous membrane - cornea, nasal/oral mucosa Uses : awake oral, nasal intubation, superficial surgical procedure Advantages : technically easy minimal equipment Disadvantages : potential for large doses leading to toxicity Local/Field Anesthesia ● ● ● ● ● ● ● Application of local subcutaneously to anesthetize distal nerve endings Uses: Suturing, minor superficial surgery, line placement, more extensive surgery with sedation Advantages: minimal equipment, technically easy, rapid onset Disadvantages: potential for toxicity if large field IV Block - “Bier” block ● ● ● ● ● ● ● Injection of local anesthetic intravenously for anesthesia of an extremity Uses any surgical procedure on an extremity Advantages: technically simple, minimal equipment, rapid onset Disadvantages: duration limited by tolerance of tourniquet pain, toxicity Peripheral nerve block ● ● ● ● ● ● ● Injecting local anesthetic near the course of a named nerve Uses: Surgical procedures in the distribution of the blocked nerve Advantages: relatively small dose of local anesthetic to cover large area; rapid onset Disadvantages: technical complexity, neuropathy Plexus Blockade ● ● ● ● ● ● ● Injection of local anesthetic adjacent to a plexus, e.g cervical, brachial or lumbar plexus Uses : surgical anesthesia or post-operative analgesia in the distribution of the plexus Advantages: large area of anesthesia with relatively large dose of agent Disadvantages: technically complex, potential for toxicity and neuropathy. Central neuraxial blockade - “Spinal” ● ● ● ● ● ● ● Injection of local anesthetic into CSF Uses: profound anesthesia of lower abdomen and extremities Advantages: technically easy (LP technique), high success rate, rapid onset Disadvantages: “high spinal”, hypotension due to sympathetic block, post dural puncture headache. Central Neuraxial Blockade - “epidural” ● ● ● ● ● ● ● Injection of local anesthetic in to the epidural space at any level of the spinal column Uses: Anesthesia/analgesia of the thorax, abdomen, lower extremities Advantages: Controlled onset of blockade, long duration when catheter is placed, post-operative analgesia. Disadvantages: Technically complex, toxicity, “spinal headache” TOXICITY OF LOCAL ANESTHETICS Rx of systemic toxicity is primarily supportive: » Stop injection » Administer oxygen » Support ventilation » Tracheal intubation and control ventilation if necessary » Suppress seizure activity (thiopental, midazolam, propofol)

Regional Anesthesia

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