REGIONAL (LOCAL) ANAESTHESIA

27 Pages·2012·0.97 MB·English

REGIONAL
(LOCAL)
ANAESTHESIA
Jozef Firment, MD PhD
Department of
Anaesthesiology & Intensive Care Medicine
Šafárik University Faculty of Medicine, Košice
A WHY REGIONAL?
I
S
E • VASCULAR COMPLICATIONS
H
Deep venous thrombosis
T
S
Lung emboli
E
A Myocardial infarction
N
Cerabral stroke
A

L • BLEEDING
A
Peroperative (> 2U blood)
N
O Postoperative with transfusion
I
G
• INFECTIONS
E
R
Wound infection
Pneumonia
Other inf. mortality
• ANOTHER COMPLICATIONS
Respiratory depresion
Renal failure
Reduction of postoperative mortality and tn
e
m
morbidity with epidural or spinal anaesthesia: riF
Results from overview of randomised trials.
2
Rogers, BMJ 2000, 321, s.1493
A
I
S
E
H
REGIONAL ANAESTHESIA
T
S
E
A
N
A
• Neuraxial blocks

L
A
– Epidural (peridural) anaesthesia
N
O
(...caudal block)
I
G
E – Subarachnoidal (spinal) anaesthesia
R
(...saddle block)
• N. plexus blocks
– (brachial plx, lumbal plx)
• Peripheral nn blocks
tn
– median n, foot block, dental block... e
m
r
iF
3
A
I
S
E ANATOMICAL SITES
H
T
S
E
A
N
• Cutaneous & Mucosal an.
A

L
• Infiltration anaesthesia
A
N
O • Peripheral nn. blocks
I
G
E • Plexus blocks
R
• Neuraxial block (Spinal &
Epidural)
The famous German
• Autonomic block
surgeon August Bier (1861-
1949) – father of spinal and
• IVRA (Bier’s block)
intravenous regional
anesthesia, around 1920. tn
e
m
Bier’s Block (1908-2008) r
iF
4
A
LONGITUDINAL CROSS-SECTION
I
S
E
OF SPINAL CANAL
H
T
S
E
A
N
A

L
A
N
O
I
G
E
R
tn
e
m
r
iF
5
Wildsmith, 1993
A TRANSVERSAL CROSS-
I
S
E SECTION OF SPINAL CANAL
H
T
S
E
A
N
A

L
A
N
O
I
G
E
R
tn
e
m
r
iF
6
Scott, 1995
A
LEVEL OF DURAL SAC PUNCTURE
I
S
E
H IN SPINAL ANAESTHESIA
T
S
E
A
N
A

L
A
N
O
I
G
E
R
tn
e
m
r
Aitkinhead 1997 iF
7
A
I
S
E
H EPIDURAL vs SPINAL
T
S
E
A
N
A E S
(Marc 0.5%) (Marc 0.5%)

L
A
Technique Epid. space LP L -L
N 2 5
O
Amount of LA 12-24 ml 1.5 - 4 ml
I
G
E Latent period 15-20 min 3-6 min
R
Sensory block ++ +++
Motor blocade + +++
Duration block 3-5 hrs +cat. 2-4 hrs
tn
e
m
r
iF
8
A
I
S
E EPIDURAL vs SPINAL
H

T
S
.
cont
E
A
N
A
E S
(Marc 0.5%) (Marc 0.5%)

L
A Catheter Yes Yes (special)
N
O
Complications DP PDPH
(70% PDPH)
I (young women)
G
E Indications longer surg. urgent
R

better m. relax.
Needles Tuohy
,
Quincke Sprotte

Whitacre, Atraucan
tn
e
m
r
iF
9
A
I USE OF LOCAL OR
S
E
H
T REGIONAL ANAESTHESIA
S
E
A
N
A

L
A
1. Surgical procedures
N
O
I
G 2. Relief of acute or chronic pain
E
R
3. Therapeutic or diagnostic
purposes
tn
e
m
r
iF
10