local and regional anesthesia

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. Types of Anesthesia contd.
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. Types of Anesthesia Care contd.
-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. Conduction Anesthesia contd.
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. 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. Local Anesthesia Techniques

10. Local Anesthesia Techniques
Lingual nerve block

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.

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Axillary nerve blocks

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. Lumbar Vertebrae

15. Positions For Spinal Block

16. -Spinal and Epidural Anesthesia

17. Spinal and Epidural Anesthesia

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)

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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.
-Caudal Block

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Caudal space

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. --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.
-Complications or
-The potential side effects

24. 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.
-Why choose
-a Local or Regional Anesthesia

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