Conduct Of Local Anesthesia Technique And Complication
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Conduct Of Local Anesthesia Technique And Complication as PDF for free.
More details
- Words: 794
- Pages: 24
Conduct of Local Anesthesia Technique And Complications .Dr . HAYTHAM ZIEN , MD M.D. Anesthesia and ICU Cairo University
S. specialist of Anesthesia K.F.U.H WWW.SMSO.NET
Advantages of Regional Anesthesia
Avoid the cardiac inhibitory effect of GA in cardiac patients . Postop. Analgesia . Patient satisfaction . Neuromuscular disease . Difficult impossible intubation Critically ill patients . Ext. operation . Embolism prevention . WWW.SMSO.NET
Regional Anesthesia
Central Neuroaxial Spinal
Epidural Caudal
Plexus block
Cervical Stillate gang Brachial Lumbar Celiac
WWW.SMSO.NET
.Peripheral N block
Local infilteration
L.A Action
L.A are Na++ch. Blockers Diffuse through the myeline sheeth block Na ++ ch. Prevent the Na entry maintain RMP prevents depolarization No Action Potential propagation WWW.SMSO.NET
Spinal Cord
Spinal cord extend to T12-L1 in adult L3 in pedia. Covered with fatty tissue, v.plexus and meningies . Pia Arachinoid Dura matter CSF between Pia – Arach . Dural sac extend to filum terminale back of S2 in adult S3 inWWW.SMSO.NET child
Physiology of neuroaxial block
Somatic Block L.A block Na ch. Prevent the action potential propagation
depend on : Fibre size Myelinated or not Drug Conc. Duration Symp. Block 2 segments above loss of Temp (Autonomic ) .
Sensory block
Motor block
2 seg above loss of pain and light touch . loss of motor and properioceptive WWW.SMSO.NET
Symp. outflow thoracolumbar T1 – L2 . Parasymp. outflow craniosacral . Neuroaxial Block block sympathetic . ↑↑ parasymp. WWW.SMSO.NET
Successful Spinal Block Autono Temp Pain touch Sensory Motor Properioceptive
WWW.SMSO.NET
Physiological Effects
CVS T1- T4 block cardiac symp. supply Parasymp. Predominant ↓↓ HR ↓↓ Contractility ↓ CO T5-L5 block symp Vascular supply VD ↓↓ VR ↓↓ CO ↓↓ BP treated by preload IV fluid 10-20ml/kg Positioning Vasopressors WWW.SMSO.NET
Resp High block may block the accessory respiratory Ms. Intercostals Total High spinal may block C4-5 Diaphragmatic (phrenic nerve). Apnea may devlop with high blocks due to ↓↓ CO ↓↓ BP ↓↓ medullary Bl. Flow WWW.SMSO.NET
Spinal Block
Midline app. Skin Subcutaneous tissue Supraspinous lig Interspinous lig Ligamntum Flvum Dura matter Aracinoid matter paramedian approach Skin S.C Lumbar apeneurosis lumbar Ms . Lig. Flavum WWW.SMSO.NET
WWW.SMSO.NET
Spinal Block
Rapid onset . Intense Block . Easy tech . Low L.A dose required . Smaller the gauge the lower P.D.P.H ( G23 –G 25 ) .
More hypotensive more CVS effect . Shorter duration ( 2 -3 hr ) Inability to extend the duration .
WWW.SMSO.NET
Epidural Anesthesia
Should not puncture dura high incidence of PDPH Slower onset . Acting on myelinated nerves . Unpredicted block level . Difficult tech. High failure rate (patchy) . High dose of L.A used systemic TOX.
Catheter prolong the duration . 72 -96 hr . Less hypotensive less CVS effect . Postop. analgesia . WWW.SMSO.NET
Complication of Spinal and Epidural anesthesia
Hypotension bradycardia . Back pain Ms strain . Local inflammation . Urine retention Post Dural puncture headache . Total (high )spinal . Inadvertent I V injection of L.A. Arachinoiditis Meningitis . Cauda equina synd. Epidural abcess Epidural hematoma WWW.SMSO.NET
P.D.P.H
Frontal headache bilateral
24 – 72 hr post puncture CSF leakage from dural puncture traction on brain sensitive structures . ppt by : female > male Large size needle treated by : rest hot drinks caffeine
analgesics IV Fluids epidural Bl. patch WWW.SMSO.NET
Contraindication Absolute patient refusal Coagulopathy Hemodynamic instability Hypovol. Infection neurological deficit High CSf pressure Relative Anticoagulant previous spine operation psychic time surgeon WWW.SMSO.NET
Brachial Plexus Block
Indication : Upper limb operation shoulder operation. Postop. analgesia . Approaches Interscaline Supraclvicular Infraclavicular Axillary
Disadvantage Difficult tech. WWW.SMSO.NET IV injection
Brachial Plexus Block
WWW.SMSO.NET
IV Regional Anesthesia Beir’s Block
In Forearm operation . Iv canula inserted . Limb evacuated from Bl
Tourniquet inflated 100mmhg > SBP . LA injected 20 -40 ml Lidocaine 2% or prilocaine
not Bupivacaine !!!!!.
Deflating after 45 min .
WWW.SMSO.NET
Caudal block and others
Caudal Block intra and postop analgesia in pediatric 1ml /kg L.A dose 15-20 ml to fill space
Ilioinguinal iliohypogastric
Penile block
circumcision
WWW.SMSO.NET
Ankle Block
Indication Foot surgery Distal toes . Depridement in Ð.
Blocking Superficial peronial Deep peronial Sural Saphenous Post. tibial . WWW.SMSO.NET
Specific procedures
Sup. Laryngeal N. Block upper airway instrumentation in difficult intubation . Cervical plexus Block Tracheostomy Thyroidectomy Intercostal Block intraop. And postop. Analgesia for WWW.SMSO.NET thoracotomies
THANK YOU DISCUSSION
WWW.SMSO.NET
S. specialist of Anesthesia K.F.U.H WWW.SMSO.NET
Advantages of Regional Anesthesia
Avoid the cardiac inhibitory effect of GA in cardiac patients . Postop. Analgesia . Patient satisfaction . Neuromuscular disease . Difficult impossible intubation Critically ill patients . Ext. operation . Embolism prevention . WWW.SMSO.NET
Regional Anesthesia
Central Neuroaxial Spinal
Epidural Caudal
Plexus block
Cervical Stillate gang Brachial Lumbar Celiac
WWW.SMSO.NET
.Peripheral N block
Local infilteration
L.A Action
L.A are Na++ch. Blockers Diffuse through the myeline sheeth block Na ++ ch. Prevent the Na entry maintain RMP prevents depolarization No Action Potential propagation WWW.SMSO.NET
Spinal Cord
Spinal cord extend to T12-L1 in adult L3 in pedia. Covered with fatty tissue, v.plexus and meningies . Pia Arachinoid Dura matter CSF between Pia – Arach . Dural sac extend to filum terminale back of S2 in adult S3 inWWW.SMSO.NET child
Physiology of neuroaxial block
Somatic Block L.A block Na ch. Prevent the action potential propagation
depend on : Fibre size Myelinated or not Drug Conc. Duration Symp. Block 2 segments above loss of Temp (Autonomic ) .
Sensory block
Motor block
2 seg above loss of pain and light touch . loss of motor and properioceptive WWW.SMSO.NET
Symp. outflow thoracolumbar T1 – L2 . Parasymp. outflow craniosacral . Neuroaxial Block block sympathetic . ↑↑ parasymp. WWW.SMSO.NET
Successful Spinal Block Autono Temp Pain touch Sensory Motor Properioceptive
WWW.SMSO.NET
Physiological Effects
CVS T1- T4 block cardiac symp. supply Parasymp. Predominant ↓↓ HR ↓↓ Contractility ↓ CO T5-L5 block symp Vascular supply VD ↓↓ VR ↓↓ CO ↓↓ BP treated by preload IV fluid 10-20ml/kg Positioning Vasopressors WWW.SMSO.NET
Resp High block may block the accessory respiratory Ms. Intercostals Total High spinal may block C4-5 Diaphragmatic (phrenic nerve). Apnea may devlop with high blocks due to ↓↓ CO ↓↓ BP ↓↓ medullary Bl. Flow WWW.SMSO.NET
Spinal Block
Midline app. Skin Subcutaneous tissue Supraspinous lig Interspinous lig Ligamntum Flvum Dura matter Aracinoid matter paramedian approach Skin S.C Lumbar apeneurosis lumbar Ms . Lig. Flavum WWW.SMSO.NET
WWW.SMSO.NET
Spinal Block
Rapid onset . Intense Block . Easy tech . Low L.A dose required . Smaller the gauge the lower P.D.P.H ( G23 –G 25 ) .
More hypotensive more CVS effect . Shorter duration ( 2 -3 hr ) Inability to extend the duration .
WWW.SMSO.NET
Epidural Anesthesia
Should not puncture dura high incidence of PDPH Slower onset . Acting on myelinated nerves . Unpredicted block level . Difficult tech. High failure rate (patchy) . High dose of L.A used systemic TOX.
Catheter prolong the duration . 72 -96 hr . Less hypotensive less CVS effect . Postop. analgesia . WWW.SMSO.NET
Complication of Spinal and Epidural anesthesia
Hypotension bradycardia . Back pain Ms strain . Local inflammation . Urine retention Post Dural puncture headache . Total (high )spinal . Inadvertent I V injection of L.A. Arachinoiditis Meningitis . Cauda equina synd. Epidural abcess Epidural hematoma WWW.SMSO.NET
P.D.P.H
Frontal headache bilateral
24 – 72 hr post puncture CSF leakage from dural puncture traction on brain sensitive structures . ppt by : female > male Large size needle treated by : rest hot drinks caffeine
analgesics IV Fluids epidural Bl. patch WWW.SMSO.NET
Contraindication Absolute patient refusal Coagulopathy Hemodynamic instability Hypovol. Infection neurological deficit High CSf pressure Relative Anticoagulant previous spine operation psychic time surgeon WWW.SMSO.NET
Brachial Plexus Block
Indication : Upper limb operation shoulder operation. Postop. analgesia . Approaches Interscaline Supraclvicular Infraclavicular Axillary
Disadvantage Difficult tech. WWW.SMSO.NET IV injection
Brachial Plexus Block
WWW.SMSO.NET
IV Regional Anesthesia Beir’s Block
In Forearm operation . Iv canula inserted . Limb evacuated from Bl
Tourniquet inflated 100mmhg > SBP . LA injected 20 -40 ml Lidocaine 2% or prilocaine
not Bupivacaine !!!!!.
Deflating after 45 min .
WWW.SMSO.NET
Caudal block and others
Caudal Block intra and postop analgesia in pediatric 1ml /kg L.A dose 15-20 ml to fill space
Ilioinguinal iliohypogastric
Penile block
circumcision
WWW.SMSO.NET
Ankle Block
Indication Foot surgery Distal toes . Depridement in Ð.
Blocking Superficial peronial Deep peronial Sural Saphenous Post. tibial . WWW.SMSO.NET
Specific procedures
Sup. Laryngeal N. Block upper airway instrumentation in difficult intubation . Cervical plexus Block Tracheostomy Thyroidectomy Intercostal Block intraop. And postop. Analgesia for WWW.SMSO.NET thoracotomies
THANK YOU DISCUSSION
WWW.SMSO.NET
Related Documents
Pharmacology Of Local Anesthesia
April 2020 10
Local Anesthesia
July 2020 19
Local Anesthesia
July 2020 6
Local Anesthesia Techniques
June 2020 11