This uploaded file is open for all fields of sphere

1. Dr. Nisar Ahmed Arain
Assistant Professor
Anesthesia / Critical Care / ICU
LOCAL AND REGIONAL
ANAESTHESIA

2. Types of Anesthesia
The administration of an anesthetic
agent is done in any part of the body
by local infiltration or topical application.
It is used for minor procedures if the
patient’s co-operation and other relative
conditions acceptable and are normal.
Local anesthesia

3. 3
Types of Anesthesia cont
It is broadly defined as a reversible loss of
sensation in a specific area or region of the body
when a local anesthetic is injected to purposefully
block or anaesthetize nerve fibers in and around
the operative site.
Commonly R.A techniques include
1-Spinals (subarachnoid block)
2-epidurals (extradural space)
3-caudal blocks, and
4-major peripheral nerve blocks.
Regional Anesthesia

4. Types of Anesthesia Care
Monitored anesthesia care (MAC)
-It is scheduled when an anesthesia provider’s presence
is necessary.
-The infiltration of the operative site with a local anesthesia
and supplements of local anesthesia like IV drugs to provide
sedation and systemic analgesia. This additional medication
may be used to optimize the patient’s physiologic status.
-This also can be used for some procedures for critically ill
patients who may poorly tolerate a general anesthetic
without extensive invasive monitoring and pharmacologic
support.-

5. 5
Types of Anesthesia Care cont
-It is administered for specific short-term
surgical, diagnostic, and therapeutic
procedures within the hospital.
-It allows patients to tolerate unpleasant
procedures while maintaining adequate
cardio-respiratory function and the ability
to respond purposefully to verbal command.
Conscious sedation/analgesia

6. Conduction Anesthesia
It is a comprehensive term which encompasses a
great variety of local and regional anesthetic
techniques.
Conduction anesthesia allows patients to undergo
many surgical procedures without significant pain or
distress. In many situations, such as cesarean section,
conduction anesthesia is safer and therefore superior
to general anesthesia. In other situations, either
conduction or general anesthesia are suitable.
Anaesthetists sometimes combine both techniques.
-Conduction anesthesia

7. 7
Conduction Anesthesia cont…
Conduction anesthesia is also used for
relief of non-surgical pain, also to enable
diagnosis of the cause of some chronic
pain conditions.
The most common form of conduction
anesthesia is probably local anesthesia to
enable dental procedures.

8. 8
Clinical techniques include
Surface anesthesia - application of local anesthetic
spray, solution or cream to the skin or a mucous
membrane. The effect is short lasting and is limited to the
area of contact.
Infiltration anesthesia - injection of local anesthetic
into the tissue to be anesthetized. Surface anesthesia
and infiltration anesthesia are collectively known as
topical anesthesia.
Field block - subcutaneous injection of a local
anesthetic in an area bordering on the field to be
anesthetized.

9. 9
Local Anesthesia Techniques

10. 10
Local Anesthesia Techniques
Lingual nerve block

11. 11
Clinical techniques include
Peripheral nerve blocks - injection of local anesthetic
agent is injected in the vicinity of a peripheral nerve to
anesthetize that nerve's area of innervation.
Plexus anesthesia - injection of local anesthetic in the
vicinity of a nerve plexus, often inside a tissue
compartment that limits the diffusion of the drug away
from the intended site of action. The anesthetic effect
extends to the innervation areas of several or all nerves
stemming from the plexus.

12. 12
Axillary nerve blocks

13. 13
Clinical techniques include
Epidural anesthesia - A local anesthetic is injected
into the epidural space where it acts primarily on the
spinal nerve roots. Depending on the site of injection
and the volume injected, the anesthetized area
varies from limited areas of the abdomen or chest to
large regions of the body.
Spinal anesthesia - a local anesthetic is injected into
the cerebrospinal fluid, usually at the lumbar spine
(in the lower back), where it acts on spinal nerve
roots and part of the spinal cord. The resulting
anesthesia usually extends from the legs to the
abdomen.

14. 14
Lumbar Vertebrae

15. 15
Positions For Spinal Block

16. 16
--Spinal and Epidural Anesthesia

17. 17
Spinal and Epidural Anesthesia

18. 18
Clinical techniques include
Blood circulation of a limb is interrupted using a
tourniquet (a device similar to a blood pressure
cuff) then a large volume of local anesthetic is
injected into a peripheral vein. The drug fills the
limb's venous system and diffuses into tissues
where peripheral nerves and nerve endings are
anesthetized. The anesthetic effect is limited
distal to the cuff.
--Intravenous regional anesthesia
-(Bier's block)

19. 19
Intravenous Regional Anesthesia

20. Caudal Block
-Anatomy of Caudal Space
-Caudal analgesia is produced
by injection of local anesthetic into
the caudal(sacral) canal. This
produces block of the sacral and
lumbar nerve roots. It is useful as a
supplement to general anesthesia
and for provision of postoperative
analgesia. This technique is popular
in pediatric patients. Catheter
insertion may be performed for
continuous caudal block.

21. 21
Caudal space

22. 22
Local Anesthetics
Local anesthetic agents can be defined as drugs which
are used clinically to produce reversible loss of
sensation in a circumscribed area of the body.
Additional drugs include Beta-adrenoceptor antagonists,
opioid analgesics, anticonvulsants and antihistamines.
Local anesthetic agents can be divided into two groups
on the basis of their chemical structure:
-amides: Lignocaine, prilocaine and bupivacaine
- esters: Amethocaine, benzocaine, cocaine
amethocaine lozenges for the
oropharynx, cocaine for nasal surgery.
Most blocks take 5 – 20 minutes to work.

23. Complications
or The potential side effects
-The most common side effect of a
block is a temporary weakness or
paralysis of the affected area.
The complications may arise when the
L.A is injected in the wrong place, e.g.,
10-20mls of L.A is injected into a vein
by mistake, it may cause convulsions
and even cardiac arrest.

24. 24
Why choose
a Local or Regional Anesthesia
L.A avoids some of the risks and unpleasantness,
such as nausea and vomiting, which sometimes
occurs with G.A.
L.A often lasts longer than the surgery, providing
pain relief for several hours after operation.
L.A may reduce blood loss.
Some patients feel more “in control” when they
are awake during surgery.

25. THANK YOU