Regional Anaesthesia : Regional Anaesthesia Presented By - Neeraj Chaudhary Slide 2: Rendering a specific area of the body insensitive to nociceptive stimulus during and after the surgical procedure. 5/3/2010 neeraj 2 Slide 3: 5/3/2010 neeraj 3 Slide 4: 5/3/2010 neeraj 4 Slide 5: 5/3/2010 neeraj 5 Slide 6: 5/3/2010 neeraj 6 Slide 7: 5/3/2010 neeraj 7 Slide 8: 5/3/2010 neeraj 8 Slide 9: Somatic blockade – LA blocks Na+ channels
Smaller > larger 5/3/2010 neeraj 9 Type of nerve fibres : Type of nerve fibres 5/3/2010 neeraj 10 Slide 11: Autonomic >> Sensory >> Motor
( Differential Blockade) 5/3/2010 neeraj 11 Slide 12: 5/3/2010 neeraj 12 Slide 13: Resp functions well maintained except in COPD patients whose respiration is dependent on abdominal muscles.
Apnoea in severe hypotension due to medullary ischemia
Other causes of apnoea- high spinal
- total spinal 5/3/2010 neeraj 13 Slide 14: 5/3/2010 neeraj 14 Slide 15: Renal blood flow maintained
Acute retention of urine due to blockade of sacral parasympathetic fibres (S2,3,4) 5/3/2010 neeraj 15 Spinal Anaesthesia : Spinal Anaesthesia Slide 17: form of regional anaesthesia involving injection of a local anaesthetic into the Subarachnoid space 5/3/2010 neeraj 17 Slide 18: 5/3/2010 neeraj 18 16 August 1898 Slide 19: 5/3/2010 neeraj 19 Slide 20: Cost.
Respiratory disease. few adverse effects on the respiratory system as long as unduly high blocks are avoided.
Diabetic patients. There is little risk of unrecognised hypoglycaemia in an awake patient. Diabetic patients can usually return to their normal food and insulin regime soon after surgery as they experience less sedation, nausea and vomiting.
Blood loss less
Visceral tone. The bowel is contracted during spinal anaesthesia and sphincters are relaxed although peristalsis continues. Normal gut function rapidly returns following surgery.
Coagulation. Post-operative deep vein thromboses and pulmonary emboli are less common following spinal anaesthesia 5/3/2010 neeraj 20 Slide 21: This technique is very useful in patients having an
irritable airway (bronchial asthma or allergic bronchitis),
anatomical abnormalities which make endotracheal intubation very difficult (micrognathia),
borderline hypertensives where administration of general anaesthesia or endotracheal intubation can further elevate the blood pressure,
procedures in geriatric patients.
technique of choice for diabetic patients. 5/3/2010 neeraj 21 Slide 22: Abdominal & vaginal hysterectomies
Hernia (inguinal or epigastric)
Piles fistulae & fissures
orthopaedic surgeries on the pelvis, femur, tibia and the ankle
trauma surgery on the lower limbs, especially if the patient is full-stomach
Transurethral resection of the prostate 5/3/2010 neeraj 22 Slide 23: ABSOLUTE –
Skin infection at inj site
Lack of consent RELATIVE-
Mini dose heparin
Demyelinating CNS ds
Fixed output cardiac lesion
Prolonged surgery 5/3/2010 neeraj 23 Slide 24: Agent / drug
Specific gravity / baricity
Inta abdominal pressure- ascites, pregnancy, obesity
Prior spinal surgery
Age 5/3/2010 neeraj 24 Local Anaesthetics for Spinal Anaesthesia : Local Anaesthetics for Spinal Anaesthesia 5/3/2010 neeraj 25 Slide 26: 5/3/2010 neeraj 26 Slide 27: Dose
Vascularity of tissue
Baricity 5/3/2010 neeraj 27 Slide 28: anaphylaxis
Cauda equina injury
Bleeding resulting in haematoma, with or without subsequent neurological sequelae due to compression of the spinal nerves
Infection: immediate within six hours of the spinal anaesthetic manifesting as meningism or meningitis or late, at the site of injection, in the form of pus discharge, due to improper sterilization of the LP set. 5/3/2010 neeraj 28 Epidural Anaesthesia : Epidural Anaesthesia Slide 30: Injection of local anesthetic in to the epidural space at any level of the spinal column
Types- 5/3/2010 neeraj 30 Slide 31: Fidel Pages first used epidural anaesthesia in humans in 1921.
In 1945 Tuohy introduced the needle which is still most commonly used for epidural anaesthesia 5/3/2010 neeraj 31 Indications (general) : Indications (general) anaesthetic for procedures involving the lower limbs, pelvis, perineum and lower abdomen
maintain continuous anaesthesia after placement of an epidural catheter 5/3/2010 neeraj 32 Indication (specific) : Indication (specific) Hip and knee surgery
Vascular reconstruction of the lower limbs
Low concentration local anaesthetics, opioids, or combinations of both
Thoracic trauma with rib or sternum fractures 5/3/2010 neeraj 33 Disadvantages: : Disadvantages: Technically complex
Chances of block failure or patchy block
High incidence of epidural hematoma
“spinal headache” 5/3/2010 neeraj 34 Slide 35: Type of epidural block
Mainly used in children for perianal surgeries, genital surgeries and for providing pain relief. 5/3/2010 neeraj 35 Slide 36: Injection of local anesthetic intravenously for anesthesia of an extremity 5/3/2010 neeraj 36 Slide 37: Uses
any surgical procedure on an extremity
technically simple, minimal equipment, rapid onset
duration limited by tolerance of tourniquet pain, toxicity 5/3/2010 neeraj 37 Peripheral nerve & plexus blocks : Peripheral nerve & plexus blocks Peripheral nerve & plexus block : Peripheral nerve & plexus block Injecting local anesthetic near the course of a named nerve
Surgical procedures in the distribution of the blocked nerve
relatively small dose of local anesthetic to cover large area; rapid onset
technical complexity, neuropathy 5/3/2010 neeraj 39 Plexus Blockade : Plexus Blockade Injection of local anesthetic adjacent to a plexus, e.g cervical, brachial or lumbar plexus
surgical anesthesia or post-operative analgesia in the distribution of the plexus
large area of anesthesia with relatively large dose of agent
technically complex, potential for toxicity and neuropathy. Brachial Plexus block : Brachial Plexus block 5/3/2010 neeraj 41 Slide 42: 5/3/2010 neeraj 42 Slide 43: 5/3/2010 neeraj 43 Slide 44: 5/3/2010 neeraj 44 Slide 45: 5/3/2010 neeraj 45 Slide 46: 5/3/2010 neeraj 46 bibliography : bibliography Clinical Anaesthesiology : morgan
Short textbook of Anaesthesia : Ajay Yadav
http://www.frca.co.uk/article.aspx?articleid=100361 5/3/2010 neeraj 47 thankyou : thankyou