3.3 Central Neuraxial Blockade

Question 1

Contraindaications tp central neuraxial blcok

Answer 1

Absolute

1. Patient Refusal
2. LA allery
3. Localised infection @ site
4. Distorted anatomy making insertion impossible

Question 2

CI to Neuraxial

Answer 2

Relative

Plts <80

Coagulopathy
Acquired sepsis / drugs
Congenital Factor VIII/IX Def
von willebrands

Severe hypovolaemic state

Severe cardiac valve lesion
stenosis - slow top ups

Question 3

Potential benefits to central block

open anterior resection

Answer 3

1. Gold standard analgesia for operation
2. Reduction post op IV opioids
3. Reduction in intraoperative blood loss
4. Potential psych and finance benefits
   - aiding speed recovery
   - time to d/c
5. Reduce Post op complications
6. Earlier recovery gut function
   enteral feeding
7. Decreased time to extubate
   LOS in ICU

Question 4

Reduction in post op complications

Answer 4

1. Mortality:
   studies prove decrease in post op morality
2. Wound infection rates
   tissue perfusion
3. MI reducion
4. VTE / PE
5. Resp depression
6. LRTI
7. N+V

Question 5

Risks

Answer 5

Early:

1. Hypotension / Bradycardia
   - may progress to CV comp / collapse
2. N+V
3. Itching
4. Shivering
5. Failure - Analgesia
6. Unilateral block
7. Subdural block
8. Dural tap
9. IT catheter
   high block / total spinal
10. IV injection

Question 6

Risks Late

Answer 6

Late

1. PDPH (extremes age)
2. Urinary retention
3. Nerve damage

• Temp or perm
• S Cord damage / ischaemia
• Tetra/ paraplegia

4. Vertebral canal haematoma
5. Infection
   superficial
   Abscess
   meningitis