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Regional Anaesthesia.pptx
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- 2. Definition Any technique toinduce 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 RegionalAnaesthesia • 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 LocalAnaesthesia • Baricity of Local Anaesthetic • Concentration of Local Anaesthetic • Position of Patient • Volume Injected • Level of Injection • Speed of Injection
- 8. Neuro-axial Block • Spinalblock • Epidural block • Caudal block
- 9. Pre-Procedure Preparation • Patient’sassessment • Explain the procedure & Obtain consent • Patient is fasting • Equipments for resuscitation & GA • IV line insertion & start fluid load • Ensure the asepsis.
- 10. Spinal Anaesthesia • Localanaesthetic 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 • Thelocal 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 EpiduralAnesthesia • 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’srefusal • Coagulopathy • Skin infection at site of insertion • Increased ICP • Hypovolemia
- 20. Relative Contraindications • Uncooperativepatient. • 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 • Itis 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 Mixtureof 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
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