Regional anaesthesia

2021 ◽  
pp. 1099-1150
Author(s):  
Mark Fairley
Keyword(s):  
Nerve Injury ◽  
Upper Limb ◽  
Local Anaesthetic ◽  
Lower Limb ◽  
Regional Anaesthesia ◽  
Coagulation Disorders ◽  
Nerve Blocks ◽  
Safe Practice ◽  
Anaesthetic Agents

This chapter discusses the techniques of regional anaesthesia and analgesia. It begins with an overview of regional anaesthesia and goes on to describe safe practice, and local anaesthetic agents. Techniques of locating nerves are then discussed, including ultrasound, and needle design is explored. Nerve blocks of the neck; upper limb; trunk; lower limb, and the neuraxis (spine) are described. Coagulation disorders, nerve injury and the management of local anaesthetic toxicity are discussed. The chapter concludes with a dermatome map and tables of recommended nerve blocks for particular operations.

Regional anaesthesia

2018 ◽  
Author(s):  
Adam Shonfeld ◽  
William Harrop-Griffiths
Keyword(s):  
Nerve Injury ◽  
Upper Limb ◽  
Local Anaesthetic ◽  
Lower Limb ◽  
Regional Anaesthesia ◽  
Coagulation Disorders ◽  
Nerve Blocks ◽  
Safe Practice ◽  
Anaesthetic Agents

This chapter discusses the techniques of regional anaesthesia and analgesia. It begins with an overview of regional anaesthesia and goes on to describe safe practice and local anaesthetic agents. Techniques of locating nerves are then discussed, including ultrasound, and needle design is explored. Nerve blocks of the neck, upper limb, trunk, lower limb, and the neuraxis (spine) are described. Coagulation disorders, nerve injury, and the management of local anaesthetic toxicity are discussed. The chapter concludes with a dermatome map and tables of recommended nerve blocks for particular operations.

Regional anaesthesia

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Local Anaesthetic ◽  
Lower Limb ◽  
Regional Anaesthesia ◽  
Anatomical Landmarks ◽  
Ultrasound Guided ◽  
Anaesthetic Agents

The regional anaesthesia chapter discusses the pharmacology of local anaesthetic agents, techniques of nerve localisation, practical aspects of ultrasound-guided blocks and the advantages and complications of regional anaesthesia. Common, and clinically useful, blocks for the upper and lower limb are described in detail with pictures of anatomical landmarks and ultrasound appearance to compliment the description. Indications, technique, volumes required and complications are described for each block.

Regional Anaesthesia

2020 ◽  
pp. 239-262
Author(s):  
Adrian Bosenberg ◽  
Jey Jeyanathen
Keyword(s):  
High Risk ◽  
Emergency Management ◽  
Upper Limb ◽  
Postoperative Analgesia ◽  
Local Anaesthetic ◽  
Lower Limb ◽  
Regional Anaesthesia ◽  
Low Resource Settings ◽  
Anaesthetic Practice ◽  
Poor Access

In low-resource settings regional anaesthesia forms an essential part of anaesthetic practice, especially in the context of poor access to postoperative analgesia and recovery facilities, or where general anaesthesia is not available or may be high risk. Safe practice for performance of regional anaesthesia is outlined as well as the emergency management of local anaesthetic toxicity. The chapter covers a range of upper limb, lower limb, and trunk blocks. It describes, where possible, ultrasound, nerve stimulator, and landmark techniques for each block since available equipment may vary. Neuraxial techniques for neonates, infants, and children are described along with local anaesthetic dosages.

Regional anaesthesia of the lower limb

2017 ◽  
Author(s):  
Pawan Gupta ◽  
Anurag Vats
Keyword(s):  
Peripheral Nerve ◽  
Local Anaesthetic ◽  
Lower Limb ◽  
Peripheral Nerves ◽  
Femoral Nerve ◽  
Epidural Haematoma ◽  
Detailed Knowledge ◽  
Success Rates ◽  
Nerve Blocks ◽  
Peripheral Nerve Stimulator

Lower limb nerve blocks gained popularity with the introduction of better nerve localization techniques such as peripheral nerve stimulation and ultrasound. A combination of lower limb peripheral nerve blocks can provide anaesthesia and analgesia of the entire lower limb. Lower limb blocks, as compared to central neuraxial blocks, do not affect blood pressure, can be used in sick patients, provide longer-lasting analgesia, avoid the risk of epidural haematoma or urinary retention, provide better patient satisfaction, and have acceptable success rates in experienced hands. Detailed knowledge of the relevant anatomy is essential before performing any nerve blocks in the lower limb as the nerve plexuses and the peripheral nerves are deep and obscured by bony structures and large muscles. The lumbosacral plexus provides sensory and motor innervation to the superficial tissues, muscles, and bones of the lower limb. This chapter covers different approaches and techniques for lower limb blocks, that is, the lumbar plexus, femoral nerve, fascia iliaca, saphenous nerve, sciatic nerve, popliteal nerve, ankle block, forefoot block, and the intra-articular infusion of local anaesthetics. Both peripheral nerve stimulator- and ultrasound-guided approaches are discussed. The use of ultrasound guidance is suggested as it helps in reducing the dose of local anaesthetic required and can ensure circumferential spread of local anaesthetic around peripheral nerves, which hastens the onset of block and improves success rate.

Regional anaesthesia of the upper limb

2017 ◽  
Author(s):  
Colin J. L. McCartney ◽  
Alan J. R. Macfarlane
Keyword(s):  
Peripheral Nerve ◽  
Upper Limb ◽  
Regional Anaesthesia ◽  
Ultrasound Guidance ◽  
Nerve Supply ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Traditional Approaches ◽  
Indications And Complications

Peripheral nerve blocks of the upper limb can provide excellent anaesthesia and postoperative analgesia. A variety of well-established traditional approaches to the brachial plexus exist, namely interscalene, supraclavicular, infraclavicular, and axillary techniques. Individual terminal nerves such as the median, radial, ulnar, and other smaller nerves can also be blocked more distally. The traditional and ultrasound-guided approach to each of these nerve blocks is discussed in turn in this chapter, along with specific indications and complications. The introduction of ultrasound guidance has generated significant excitement in this field in the last 10 years and has been demonstrated to improve efficacy and reduce complications. However, a sound knowledge of anatomy of the nerve supply to the upper limb remains essential during any upper limb regional anaesthesia technique.

BILATERAL ULNAR NERVE BLOCKS FOR THE EVALUATION OF LOCAL ANAESTHETIC AGENTS

1966 ◽  
Vol 10 (3) ◽  
pp. 278
Author(s):  
J. ALB??RT ◽  
B. L??STR??M ◽  
ROBERT W. VIRTUE
Keyword(s):  
Ulnar Nerve ◽  
Local Anaesthetic ◽  
Nerve Blocks ◽  
Anaesthetic Agents

Regional anaesthesia

2020 ◽  
pp. 247-269
Author(s):  
Dr. Owen Davies
Keyword(s):  
Peripheral Nerve ◽  
Local Anaesthetic ◽  
Regional Anaesthesia ◽  
Epidural Haematoma ◽  
Nerve Injuries ◽  
Nerve Blocks ◽  
Ischaemic Injury ◽  
Peripheral Nerve Blocks ◽  
Surgical Emergencies ◽  
Life Threatening

There are a number of important emergencies associated with regional anaesthesia that the anaesthetist should be aware of. Life-threatening emergencies, such as local anaesthetic systemic toxicity leading to cardiorespiratory arrest can occur irrespective of the site of local anaesthetic infiltration. Specific procedures including epidural and spinal anaesthesia, eye blocks, and peripheral nerve blocks cause a range of surgical emergencies and severe complications. Neuraxial anaesthesia carries the risk of epidural haematoma and abscess while infiltration or local anaesthetic around the globe carries the risk of both retro-orbital haematoma and globe perforation, all of which may require urgent surgical intervention. Although literature supports the safety of low concentration (1 in 200 000) adrenaline as an additive to digital blocks, inadvertent injection of higher concentrations may have the potential for ischaemic injury. Finally, the assessment and diagnosis of perioperative nerve injuries when associated with a peripheral nerve block present a formidable clinical challenge.

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