Regional Anesthesia
Regional Anesthesia
What is Regional Anesthesia?
Nerve Sensitivity
Autonomic >> Sensory >> Motor
Neuraxial
Spinal
Epidural
Caudal
Peripheral Nerve Block
IV Regional ( Bier block )
Spinal Anesthesia
Local Anesthetic Physiology
Hyperbaric
(Dextrose)
Isobaric
Hypobaric
Spread of Local Anesthesia
• Baricity of Local Anesthetic
• Position of Patient
• Concentration of Local Anesthetic
• Volume Injected
• Level of Injection
• Speed of Injection
Advantages
• Cheap
• High Patient Satisfaction
• Well Tolerated in Pulmonary Disease
• Maintain Patent Airway
• Selective Muscle Relaxation
• Decreased Blood Loss
• Decreased Incidence of DVT and PE
Disadvantages
• Difficult Placement in Elderly
• Hypotension
• Patient Can Talk
• Patient Anxiety
• Not Reliable for Surgery > 2 hours
Complications
• Bleeding
• Post-Dural Puncture Headache
• Transient Neurological Syndrome
• Total Spinal
Total Spinal
• Hypotension
• Bradycardia
• Arm involvement
• Shortness of Breath
• Patient Anxiety
• Loss of Consciousness
Contra-Indications
• Inadequate equipment for GA
• Bleeding Dyscrasia’s
• Hypovolemia
• Patient Refusal
• Sepsis/Bactermia
• Anatomic Deformities of the Spine
• Neurological Disease
• Increased ICP
• Fixed Cardiac Output States
Epidural Anesthesia
Uses
• Hip and Knee Surgery
• Lower Extremity Vascular Surgery
• Lower Extremity Amputation
• Obstetrical – Labor & C/S
• Thoracic Surgery – Post-Op Pain Control
• Thoracic Trauma
• Abdominal Surgery – Post-Op Pain
Control
Advantages
• Cheap
• High Patient Satisfaction
• Well Tolerated in Pulmonary Disease
• Maintain Patent Airway
• Selective Muscle Relaxation
• Decreased Blood Loss
• Decreased Incidence of DVT and PE
Disadvantages
• Difficult Placement in Elderly
• Hypotension
• Patient Can Talk
• Patient Anxiety
Complications
• High Epidural
• Local Anesthetic Toxicity
• Total Spinal
• Accidental Dural Puncture
Contra-Indications
• Patient Refusal
• Coagulopathy
• Localized Skin Infection
• Elevated ICP
• Hypovolemia
• Uncooperative Patient
• Pre-Existing Neurological Disease
• Spinal Column Abnormalities
• Fixed Cardiac Output States
Peripheral Nerve Blocks
• Brachial Plexus
• Psoas Compartment Block
• Femoral Nerve Block
• Popliteal Fossa Block
• Ankle Block
Intravenous Regional Anesthesia
( Bier block )
Applications
• Distal Arm Surgery
• Useful for Short Procedures
Contra-Indications
• Sickle Cell Disease
• Crush Injury to the Limb
• Very Young may need additional
Complications
• Local Anesthetic Toxicity
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