Conduct Of Local Anesthesia Technique And Complication

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Conduct Of Local Anesthesia Technique And Complication

  1. 1. Conduct of Local Anesthesia Technique And Complication s Dr.Husni Ajaj 09/11/11 Dr.Husni Ajaj
  2. 2. Advantages of Regional Anesthesia <ul><li>Avoid the cardiac inhibitory effect of GA in cardiac patients . </li></ul><ul><li>Postop. Analgesia . </li></ul><ul><li>Patient satisfaction . </li></ul><ul><li>Neuromuscular disease . </li></ul><ul><li>Difficult impossible intubation </li></ul><ul><li>Critically ill patients . </li></ul><ul><li>Ext. operation . </li></ul><ul><li>Embolism prevention . </li></ul>09/11/11 Dr.Husni Ajaj
  3. 3. 09/11/11 Dr.Husni Ajaj Regional Anesthesia Central Neuroaxial Spinal Epidural Caudal Plexus block Peripheral N. block Local infilteration Cervical Stillate gang Brachial Lumbar Celiac
  4. 4. L.A Action <ul><li>L.A are Na ++ ch. Blockers </li></ul><ul><li>Diffuse through the myeline sheeth block Na ++ ch. </li></ul><ul><li>Prevent the Na entry maintain RMP prevents depolarization No Action Potential propagation </li></ul>09/11/11 Dr.Husni Ajaj
  5. 5. Spinal Cord <ul><li>Spinal cord extend to T12-L1 in adult L3 in pedia. </li></ul><ul><li>Covered with fatty tissue, v.plexus and meningies . </li></ul><ul><li>Pia Arachinoid Dura matter </li></ul><ul><li>CSF between Pia – Arach . </li></ul><ul><li>Dural sac extend to filum terminale back of S2 in adult S3 in child </li></ul>09/11/11 Dr.Husni Ajaj
  6. 6. Physiology of neuroaxial block <ul><li>Somatic Block L.A block Na ch. Prevent the action potential propagation </li></ul><ul><li>depend on : Fibre size Myelinated or not Drug Conc. Duration </li></ul><ul><li>Symp. Block 2 segments above loss of Temp (Autonomic ) . </li></ul><ul><li>Sensory block 2 seg above loss of pain and light touch . </li></ul><ul><li>Motor block loss of motor and properioceptive </li></ul>09/11/11 Dr.Husni Ajaj
  7. 7. <ul><li>Symp. outflow thoracolumbar T1 – L2 . </li></ul><ul><li>Parasymp. outflow craniosacral . </li></ul><ul><li>Neuroaxial Block block sympathetic . </li></ul><ul><li>  parasymp. </li></ul>09/11/11 Dr.Husni Ajaj
  8. 8. Successful Spinal Block 09/11/11 Dr.Husni Ajaj Autono Temp Pain touch Sensory Motor Properioceptive
  9. 9. Physiological Effects <ul><li>CVS T1- T4 block cardiac symp. supply Parasymp. Predominant  HR  Contractility  CO T5-L5 block symp Vascular supply VD </li></ul><ul><li> VR  CO  BP </li></ul><ul><li>treated by preload IV fluid 10-20ml/kg Positioning Vasopressors </li></ul>09/11/11 Dr.Husni Ajaj
  10. 10. <ul><li>Resp High block may block the accessory respiratory Ms. Intercostals Total High spinal may block C4-5 Diaphragmatic (phrenic nerve). </li></ul><ul><li>Apnea may devlop with high blocks due to  CO  BP  medullary Bl. Flow </li></ul>09/11/11 Dr.Husni Ajaj
  11. 11. Spinal Block <ul><li>Midline app. Skin Subcutaneous tissue Supraspinous lig Interspinous lig Ligamntum Flvum Dura matter Aracinoid matter </li></ul><ul><li>paramedian approach Skin S.C Lumbar apeneurosis lumbar Ms . Lig. Flavum </li></ul>09/11/11 Dr.Husni Ajaj
  12. 12. 09/11/11 Dr.Husni Ajaj
  13. 13. Spinal Block <ul><li>Rapid onset . </li></ul><ul><li>Intense Block . </li></ul><ul><li>Easy tech . </li></ul><ul><li>Low L.A dose required . </li></ul><ul><li>Smaller the gauge the lower P.D.P.H ( G23 – G 25 ) . </li></ul><ul><li>More hypotensive more CVS effect . </li></ul><ul><li>Shorter duration ( 2 -3 hr ) </li></ul><ul><li>Inability to extend the duration . </li></ul>09/11/11 Dr.Husni Ajaj
  14. 14. Epidural Anesthesia <ul><li>Should not puncture dura high incidence of PDPH </li></ul><ul><li>Slower onset . Acting on myelinated nerves . </li></ul><ul><li>Unpredicted block level . </li></ul><ul><li>Difficult tech. </li></ul><ul><li>High failure rate (patchy) . </li></ul><ul><li>High dose of L.A used systemic TOX. </li></ul><ul><li>Catheter prolong the duration . </li></ul><ul><li>72 -96 hr . </li></ul><ul><li>Less hypotensive less CVS effect . </li></ul><ul><li>Postop. analgesia . </li></ul>09/11/11 Dr.Husni Ajaj
  15. 15. Complication of Spinal and Epidural anesthesia <ul><li>Hypotension bradycardia . </li></ul><ul><li>Back pain Ms strain . </li></ul><ul><li>Local inflammation . </li></ul><ul><li>Urine retention </li></ul><ul><li>Post Dural puncture headache . </li></ul><ul><li>Total (high )spinal . </li></ul><ul><li>Inadvertent I V injection of L.A. </li></ul><ul><li>Arachinoiditis Meningitis . </li></ul><ul><li>Cauda equina synd. </li></ul><ul><li>Epidural abcess </li></ul><ul><li>Epidural hematoma </li></ul>09/11/11 Dr.Husni Ajaj
  16. 16. P.D.P.H <ul><li>Frontal headache bilateral </li></ul><ul><li>24 – 72 hr post puncture </li></ul><ul><li>CSF leakage from dural puncture traction on brain sensitive structures . </li></ul><ul><li>ppt by : </li></ul><ul><li>female > male </li></ul><ul><li>Large size needle </li></ul><ul><li>treated by : </li></ul><ul><li>rest hot drinks caffeine analgesics IV Fluids epidural Bl. patch </li></ul>09/11/11 Dr.Husni Ajaj
  17. 17. Contraindication <ul><li>Absolute </li></ul><ul><li>patient refusal Coagulopathy Hemodynamic instability Hypovol. Infection neurological deficit High CSf pressure </li></ul><ul><li>Relative Anticoagulant previous spine operation psychic time surgeon </li></ul>09/11/11 Dr.Husni Ajaj
  18. 18. Brachial Plexus Block <ul><li>Indication : Upper limb operation shoulder operation. Postop. analgesia . </li></ul><ul><li>Approaches Interscaline Supraclvicular Infraclavicular Axillary </li></ul><ul><li>Disadvantage Difficult tech. IV injection of LA Pneumothorax </li></ul>09/11/11 Dr.Husni Ajaj
  19. 19. Brachial Plexus Block 09/11/11 Dr.Husni Ajaj
  20. 20. IV Regional Anesthesia Beir’s Block <ul><li>In Forearm operation . </li></ul><ul><li>Iv canula inserted . </li></ul><ul><li>Limb evacuated from Bl </li></ul><ul><li>Tourniquet inflated 100mmhg > SBP . </li></ul><ul><li>LA injected 20 -40 ml Lidocaine 2% or prilocaine </li></ul><ul><li>not Bupivacaine !!!!!. </li></ul><ul><li>Deflating after 45 min . </li></ul>09/11/11 Dr.Husni Ajaj
  21. 21. Caudal block and others <ul><li>Caudal Block intra and postop analgesia in pediatric 1ml /kg L.A dose 15-20 ml to fill space </li></ul><ul><li>Ilioinguinal iliohypogastric </li></ul><ul><li>Penile block circumcision </li></ul>09/11/11 Dr.Husni Ajaj
  22. 22. Ankle Block <ul><li>Indication Foot surgery Distal toes . Depridement in Ð. </li></ul><ul><li>Blocking Superficial peronial Deep peronial Sural Saphenous Post. tibial . </li></ul>09/11/11 Dr.Husni Ajaj
  23. 23. Specific procedures <ul><li>Sup. Laryngeal N. Block upper airway instrumentation in difficult intubation . </li></ul><ul><li>Cervical plexus Block Tracheostomy Thyroidectomy </li></ul><ul><li>Intercostal Block intraop. And postop. Analgesia for thoracotomies </li></ul>09/11/11 Dr.Husni Ajaj
  24. 24. THANK YOU DISCUSSION 09/11/11 Dr.Husni Ajaj

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