Regional Anesthesia

Course

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

             THANK YOU

Khalid Ibrahim Aljonaieh, MD, MS