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Lec5 - Anasthesia

The document discusses local and regional anaesthesia, highlighting the differences between analgesia and anaesthesia, and the benefits of regional techniques for both patients and surgeons. It outlines various techniques, including spinal anaesthesia, and emphasizes the importance of monitoring and resuscitation facilities during procedures. Additionally, it lists potential complications and contraindications associated with regional anaesthesia.

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Taha Muhammed
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3 views6 pages

Lec5 - Anasthesia

The document discusses local and regional anaesthesia, highlighting the differences between analgesia and anaesthesia, and the benefits of regional techniques for both patients and surgeons. It outlines various techniques, including spinal anaesthesia, and emphasizes the importance of monitoring and resuscitation facilities during procedures. Additionally, it lists potential complications and contraindications associated with regional anaesthesia.

Uploaded by

Taha Muhammed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Lec 5

Local & Regional Anaesthesia

The terms “analgesia” and “anaesthesia” are used to local and regional
techniques and the drugs used. Lignocaine and bupivacaine are the most
drugs used.

 Analgesia the state when only relief of pain is provided. This may allow
some minor surgical procedures to be performed, e.g, infiltration
analgesia for suturing.
 Anaesthesia the state when analgesia is accompanied by muscle
relaxation, usually to allow major surgery to be undertaken. Regional
anaesthesia may be used alone or in combination with general
anaesthesia.

The role of local & regional anaesthesia

Regional anaesthesia is not just an answer to the problem of anesthesia in


patients regarded as not well enough for general anesthesia. The decision
to use these techniques should be based on the advantages offered to
both patients and surgeon

1. Analgesia or anaesthesia is provided in area required, thereby avoiding


the systemic effects of the drugs.
2. In patients with chronic respiratory disease, spontaneous ventilation
can be preserved and respiratory depressant drugs avoided.

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3. The airways reflexes are preserved and in a patient with full stomach,
the risk of aspiration is reduced.
4. Central neural blockade may improve access and facilitate surgery. e.g;
by causing contraction of the bowel or by providing profound muscle
relaxation.
5. Blood loss can be reduced with controlled hypotension.
6. There is a considerable reduction in the equipment and the cost of
anesthesia (this is important in underdeveloped).
7. Some technique can be continued post-operatively to provide pain
relief, e.g, an epidural.
8. Complications after major surgery are significantly reduced,
particularly orthopedic surgery.

© Never ever force a patient to accept a local or regional technique,


instead reassure and explain.

Whenever a local or regional technique is used, facilities for resuscitation


must always be immediately available in order that allergic reaction and
toxicity can be dealt with effectively. At a minimum this will include the
following:

 Equipment to secure and maintain the airways; give oxygen and provide
ventilation.
 Intravenous cannulae and range of fluids.
 Drugs, including epinephrine, atropine, vasopressors and
anticonvulsants.
 Suction.
 A surface to the patient that is capable of being head-down.

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Techniques

 Topical to a mucous membrane, like eye or urethra.


 Subcutaneous infiltration.
 Intravenously after application of a tourniquet (IVRA Bier's Block )
 Directly around nerves, like brachial plexus block.
 In the extradural space ( Epidural )
 In the subarachnoid space ( Spinal or Subdural )
The latter two techniques are more correctly called ( Central Neural
Blockade )

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Spinal Anesthesia

Spinal (intrathecal) anaesthesia result from injection of a local anesthetic


drug into the cerebrospinal fluid (CSF), with the subarachnoid space.
The spinal needle can only be inserted below the 2nd lumbar and above the
1st sacral vertebrae; the upper limit is determined by the termination of
the spinal cord, and the lower limit by the fact the sacral vertebrae are
fused and access becomes virtually impossible. A single injection of local
anesthetic is usually used, thereby limiting the duration of the technique.

A fine needle with pencil point tip is used. The small diameter and shape
are an attempt to reduce the incidence of postdural puncture headache
(PDPH). To aid a passage of this needle through the skin and interspinous
ligament, a short, wide-bore needle is introduced initially and the spinal
needle passed through its lumen.

Factors influencing the spread of the local anesthetic drug within the
CSF, and hence the extent of anesthesia, include:

 Use of hyperbaric solutions ( i.e. its specific gravity is greater than


that of CSF ), this is achieved by the addition of 8% dextrose to
the local anesthetic solution. Posture is then used to control spread.
 Positioning of the patient either during or after the injection.
Maintenance of the sitting position after injection results in a block
of the low lumbar and sacral nerves. In the supine position, the
block will extend to the thoracic nerves around T5-6, the point of
maximum backwards curve (Kyphosis) of the thoracic spine. Further
extension can be obtained with head-down tilt.
 Increasing the dose (volume and/or concentration) of local
anesthetic drug.
 The higher the placement of the spinal anesthetic in the lumbar, the
higher the level of block obtained.
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® Small doses of an opioid ( Morphine ) may be injected with the local
anesthetic, this extends the duration of analgesia for up to 24 h post-
operatively.

Monitoring during regional anaesthesia

A conscious patient is not an excuse for an adequate monitoring!


Particular attention must be paid to the cardiovascular system as a
result of the profound effects of these technique. Maintenance of
verbal contact with the patient is useful as it gives an indication of
cerebral perfusion. Early signs of inadequate cardiac output are
nausea, faintness & subsequent vomiting. The first indication of
extensive spread of anaesthesia may be a complaint of difficulty with
breathing of numbness in the fingers. These signs will be lost if the
patient is heavily sedated.

Complications

1. Hypotension & bradycardia


2. Nausea & vomiting
3. Postdural puncture headache

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Contraindications

1. Hypovolaemia
2. A low fixed cardiac output
3. Local skin sepsis
4. Coagulopathy
5. Raised intracranial pressure
6. Known allergy to local anaesthetic drugs
7. A patient totally uncooperative
8. Previous spinal surgery

The End

Wish U the best, deserve it.

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