regional anaesthesia

1. Regional Anaesthesia
-Aryan Panjoria
-Final Proff.
23

2. Definition
Any technique to induce the absence of
sensation in part of the body

3. Why Regional Anaesthesia?
• Cheap
• High Patient Satisfaction
• Maintain Patent Airway
• Decreased Blood Loss
• Selective Muscle Relaxation
•Decreased Incidence of
DVT & PE

4. Why Not Regional Anaesthesia
• Hypotension
• Risk of toxicity
• Many patients prefer to be asleep
• Skills are required
• Patient Can Talk
• Patient Anxiety
• Not Reliable for Surgery > 2 hours

5. Regional anesthesia - Types
• Topical
• Intravenous (Bier’s) block
• Peripheral nerve block
• Plexus: brachial, lumbar
• Neuro-axial block

6. Regional anesthesia - Uses
• Provide anesthesia for a surgical
procedure.
• Provide analgesia post-operatively or
during labor and delivery.
• Therapy for patients with chronic pain
syndromes, cancer.

7. Spread of Local Anaesthesia
• Baricity of Local Anaesthetic
• Concentration of Local Anaesthetic
• Position of Patient
• Volume Injected
• Level of Injection
• Speed of Injection

8. Neuro-axial Block
• Spinal block
• Epidural block
• Caudal block

9. Pre-Procedure Preparation
• Patient’s assessment
• Explain the procedure & Obtain consent
• Patient is fasting
• Equipments for resuscitation & GA
• IV line insertion & start fluid load
• Ensure the asepsis.

10. Spinal Anaesthesia
• Local anaesthetic injected into the CSF in sub-
arachanoid space. Between L3-L4
• Patient’s postion : Lateral or Sitting position
• Approach : Midline or Para-median
• Anaesthetic used : Heavy Bupivacaine
• Indication : can be used in the surgeries below
the umblicus
• 23-29 G needles used
• Single dose required

13. Complications
• Hypotension
• Bradycardia
• Postdural puncture headache(PDPH)
• Respiratory depression
• Meningitis
• Cauda equina syndrome

14. Epidural Anaesthesia
• The local anaesthetic is injected in the
epidural space to block the nerves emerging
from the spinal cord.
• Position : lateral or sitting position
• Approach : Midline or para median
• Anaesthetic used: bupivacaine
• 16-20G needles used. A catheter is attached
• Larger amount of LA in multiple doses
required

18. Complications of Epidural Anesthesia
• Anaphylaxis
• Pain
• Post-spinal headache
• Hypotension & Bradycardia
• Nerve damage
• Respiratory failure
• Epidural or intra-thecal bleed
• Spinal cord hematoma
• Infection
• Urinary retention

19. Absolute Contraindications
• Patient’s refusal
• Coagulopathy
• Skin infection at site of insertion
• Increased ICP
• Hypovolemia

20. Relative Contraindications
• Uncooperative patient.
• Pre-existing neurological disorder.
• Fixed cardiac output states (AS, MS,
HOCM, 3rddegree heart block).
• Anatomic abnormalities.
• Prophylactic low dose heparin use.

21. Peripheral Nerve Blocks
• Regional anaesthesia is induced by injecting
the LA around the Nerve Plexus or individual
nerves.
• Example :
-Brachial plexus block for upper limb surgeries.
- nerve block
- wrist block
• Ultrasound may be used

23. Bier Block
• It is a type of Intravenous block where the LA is
injected into the vein via a cannuala to achieve
Regional anaesthesia.
• Indication : surgical procedures below the elbow
and below the knee.
• 22G catheter is used with a double cuff
tourniquet
• LA used : 30ml of 0.5% Ligno
• Cuff pressure should be 50mm of hg above
systolic BP
• Can be used only for short procedures

25. Contraindications
• Raynauld’s disease
• Sickle cell anemia
• Young children
• Shock
• Multiple trauma
• Seizure disorder

26. Complication
• Tourniquet pain
• Erythema at the IV site
• If Tourniquet fails
1. Headache
2. Cardiovascular collapse
3. Seizure
4. bradycardia

27. EMLA
• Eutectic Mixture of Local Anesthetics
• Contains : Lidocaine 2.5% & Prilocaine 2.5%
• Applied topically on the intact skin and
mucous membranes
• Given 1hr before procedure
• Numbness lasts upto a depth a 5mm for 1-2
hrs

28. Thank you