Regional Anaesthesia seminar

Regional Anaesthesia : 

Regional Anaesthesia Presented By - Neeraj Chaudhary

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Rendering a specific area of the body insensitive to nociceptive stimulus during and after the surgical procedure. 5/3/2010 neeraj 2

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Somatic blockade – LA blocks Na+ channels Nerve Sestivity Myelinated >unmyelinated Smaller > larger 5/3/2010 neeraj 9

Type of nerve fibres : 

Type of nerve fibres 5/3/2010 neeraj 10

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Autonomic >> Sensory >> Motor ( Differential Blockade) 5/3/2010 neeraj 11

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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

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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

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form of regional anaesthesia involving injection of a local anaesthetic into the Subarachnoid space 5/3/2010 neeraj 17

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5/3/2010 neeraj 18 16 August 1898

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Cost. Respiratory disease. few adverse effects on the respiratory system as long as unduly high blocks are avoided. Patent airway.. 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. Muscle relaxation.. 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

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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

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Abdominal & vaginal hysterectomies Caesarean sections Hernia (inguinal or epigastric) Piles fistulae & fissures orthopaedic surgeries on the pelvis, femur, tibia and the ankle nephrectomy cholecystectomy trauma surgery on the lower limbs, especially if the patient is full-stomach Open tubectomies Transurethral resection of the prostate 5/3/2010 neeraj 22

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ABSOLUTE – Sepsis Bacteremia Skin infection at inj site Severe hypovolemia Raised ICT Lack of consent RELATIVE- Peripheral neuropathy Mini dose heparin Demyelinating CNS ds Fixed output cardiac lesion Uncooperative pt Prolonged surgery 5/3/2010 neeraj 23

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Agent / drug Specific gravity / baricity Vasoconstrictor Posture 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

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Dose Lipid solubility Vascularity of tissue Baricity 5/3/2010 neeraj 27

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anaphylaxis Backach Headach (PDPH) Urinary retention Spinal shock. Cauda equina injury Hypothermia Meningitis Broken needle 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

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Injection of local anesthetic in to the epidural space at any level of the spinal column Types- 5/3/2010 neeraj 30

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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 postoperative analgesia 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 Amputation Obstetrics 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 Total spinal “spinal headache” 5/3/2010 neeraj 34

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Type of epidural block Mainly used in children for perianal surgeries, genital surgeries and for providing pain relief. 5/3/2010 neeraj 35

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Injection of local anesthetic intravenously for anesthesia of an extremity 5/3/2010 neeraj 36

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Uses any surgical procedure on an extremity Advantages: technically simple, minimal equipment, rapid onset Disadvantages: 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 Uses: Surgical procedures in the distribution of the blocked nerve Advantages: relatively small dose of local anesthetic to cover large area; rapid onset Disadvantages: 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 Uses : surgical anesthesia or post-operative analgesia in the distribution of the plexus Advantages: large area of anesthesia with relatively large dose of agent Disadvantages: technically complex, potential for toxicity and neuropathy.

Brachial Plexus block : 

Brachial Plexus block 5/3/2010 neeraj 41

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bibliography : 

bibliography Clinical Anaesthesiology : morgan Short textbook of Anaesthesia : Ajay Yadav http://www.nda.ox.ac.uk/wfsa/html/u12/u1208.htm http://www.frca.co.uk/article.aspx?articleid=100361 5/3/2010 neeraj 47

thankyou : 

thankyou