Regional anesthesia

Last updated: October 20, 2022

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Regional anesthesia involves the infiltration of local anesthetic agents around nerves or nerve bundles in order reversibly block pain conduction in the innervated tissue. Regional anesthesia techniques can be divided into regional peripheral nerve blocks (PNB) and neuraxial anesthesia (e.g., spinal and epidural).

See also “Local anesthesia” and “Local anesthetic agents.”

Local and regional anesthesia are used prior to certain medical procedures to reduce pain.

  • Definition: Local anesthetic is injected near a specific nerve or nerve bundle.
  • Indications
    • Surgery of the upper extremities
      • Interscalene block
      • Supraclavicular plexus block
      • Vertical infraclavicular plexus block
      • Axillary brachial plexus block
    • Surgery of the lower extremities
    • Surgery of the scalp, neck, and trunk
    • Block of selected peripheral nerves (e.g., digital nerve block): technique to anesthetize the digits to perform surgery on the fingers or toes.
  • Relative contraindication: coagulopathy
  • Procedure
    • Injection site: depends on the nerves that need to be blocked
    • Technique
      • The patient is placed in a position that is tolerable for him or her and allows the practitioner to access the relevant nerve easily (e.g., to apply an axillary plexus block, the hand is placed underneath the head with the arm abducted and bent.)
      • Hygiene: hand disinfection, sterile gloves, sterile face mask, utensils for wipe disinfection of the puncture site afterward, (if catheter is inserted, also sterile gown and sterile fenestrated drape)
      • Identification of the relevant nerve guided by specific landmarks and/or:
      • Two approaches to inject the local anesthetic drugs are available:

Peripheral nerve blocks are preferred over general anesthesia in patients with respiratory problems and preferred over epidural/spinal anesthesia in patients who are at high risk for urinary retention or other side effects of these procedures.

References:[1]

All procedures

Epidural/spinal anesthesia [2][3]

Total spinal anesthesia

We list the most important complications. The selection is not exhaustive.

  1. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003; 91 (5): p.718-729. doi: 10.1093/bja/aeg231 . | Open in Read by QxMD
  2. Clinical Relevance of the Bezold–Jarisch Reflex. http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1943118. Updated: May 1, 2003. Accessed: February 20, 2017.
  3. Gimeno AM, Errando CL. Neuraxial regional anaesthesia in patients with active infection and sepsis: a clinical narrative review. Turk J Anaesthesiol Reanim. 2018; 46 (1): p.8-14. doi: 10.5152/TJAR.2018.12979 . | Open in Read by QxMD
  4. Agabegi SS, Agabegi ED. Step-Up To Medicine. Wolters Kluwer Health ; 2015

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