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Introduction to Regional

Anesthesia

Dr T Semei

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Spinal

What is Regional Anesthesia ?

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Types

Spinal

Epidural

Nerve blocks

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L3-L4 interspace

Skin,subcutaneous structures, supraspinous

ligament,interspinous ligament, ligamentum

flavum, dura matter, aracnoid membrane

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Advantages

Metabolic stress reduced

20-30 % reduction in blood loss

Less pulmonary compromise No endotracheal intubation

Mental status can be followed

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Factors involved in distribution

Patient height, position , abdominal pressure

Needle site

Dose, volume ,concentration Baricity /ratio of density of local to CSF

(hypobaric, hyperbaric, isobaric)

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Complications

Bradycardia

Hypotension

Nausea

Vomiting

Post dural puncture headache

Heamatoma

Abcess

Total spinal

Direct trauma to nerves

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Contraindications

Infection at site

Severe hypovolemia

Intracranial hypertension coagulopathy

Low back pain ?

Sepsis? Nuerological disease?

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Epidural

Skin, subcutaneous fat, supraspinous

ligament, interspinous ligament, ligamentum

flavum, epidural space

various levels ---

cervicalthoraciclumbarcaudal

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Filling potential space

Increased dose

Onset slower One shot or continuous

Epidural located by feel

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Advantages

Over spinal-

less hypotension,

gradual onset, redosing to maintain level,

flexiblity of block

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Complications

Hypotension

Intravascular injection

Spinal Post dural puncture headache

Epidural heamatoma

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What do we use

Local anesthetics

opiods

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Types of blocks

Upper limb-

interscalene blocks

Axillary nerve blocks Supraclavicular

Infraclavicular

Ulnar radial

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Lower limb

Lumbar plexus

Femoral Popliteal

Ankle

Sciatic

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Explain procedure

-+ sedation

Know anatomy Peripheral nerve stimulator

Ultrasound

parasthesia

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Contraindications

Infection to site

Patient refusal

Uncooperative patient

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Complications

Infection

Damage to adjacent structures

Local anesthetic toxicity

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The End