Regional Anaesthesia

Question 1

Regional Anaesthesia

Answer 1

“blocks”
Sympathetic blockade (sympathectomy) stops stress response
earlier mobilisation, quicker recovery

Question 2

Types of Regional Anaesthesia

Answer 2

Neuraxial Nerve Block
Peripheral Nerve Blocks
Plane Blocks

1. Neuraxial
   Spinal
   Epidural
   Caudal
2. Peripheral Nerve Blocks: Nerve Categories
   Nerve Root blocks
   - paravertebral
   - intercostal
   Nerve trunk blocks
   - femoral
   - sciatic
   - ilioinguinal
   Digit nerve blocks
   - ring block
   - penile block

3.Peripheral Nerve Blocks: Plexus Blocks
Brachial plexus blocks
- interscalene
- supraclavicular
- infraclavicular
Lumbar plexus block

4. Plane Blocks
   Transversus abdominus plane (TAP) block
   Rectus sheath block
   Pectoral block

Question 3

Spinal vs Epidural Anaesthesia

Answer 3

Spinal = LA injected into subarachnoid space containing CSF, to act on spinal roots and spinal cord (Bupivacaine)

Epidural = LA injected into epidural space blocking spinal roots (lignocaine, Bupivacaine)

Question 4

IV regional anaesthesia

Answer 4

LA injected IV distal to pressure cuff to arrest blood flow
remains effective until circulation is restored. Used for limb surgery

Question 5

What would you use for shoulder surgery

Answer 5

o The interscalene brachial plexus block (ISB) is the gold standard technique
o Phrenic nerve palsy association with the interscalene block (100%)  beware of using this in a patient who has compromised lungs

Question 6

What would you use for surgery distal to middle third of humerus

Answer 6

o Supraclavicular (SCB) / infraclavicular blocks (ICB) are suitable
o SCB  phrenic nerve palsy is less common (30%) however, pneumothorax can happen if not
done properly

Question 7

What would you use for thoracotomy

Answer 7

Thoracic epidural

Question 8

What would you use for midline laparotomy

Answer 8

Rectus sheath block

Question 9

What would you use for breast surgery

Answer 9

Pectoral major 2 blocks

Question 10

Complications of interscalene block:

Answer 10

• Phrenic nerve block  100%
• Injection into vertebral artery  convulsion
• Subarachnoid injection  “total spinal”
• Blockade of cervical sympathetic  Horner’s syndrome
• Recurrent laryngeal nerve involvement  rare

Question 11

Complications of Supraclavicular blocks:

Answer 11

• Pneumothorax
• Phrenic nerve block
• Horner’s syndrome

Question 12

What would you use for knee, femur, medial tibia, first toe, medial foot surgery

Answer 12

Femoral nerve block
MUST combine with sciatic nerve block

Question 13

What would you use for foot and ankle surgery lateral aspects

Answer 13

Sciatic nerve block