Regional anaesthesia

Question 1

Which limbs of the triad of anaesthesia does regional anaesthesia cover?

Answer 1

Analgesia

Muscle relaxation

Question 2

Two techniques of regional anaesthesia

Answer 2

1. Central (neuraxial block - spinal, epidural or caudal)

2. Peripheral (plexus and single nerve blocks)

Question 3

Indications for regional aneasthesia

Answer 3

1. Surgical anaesthesia
2. Supplement a GA
3. Post-operative pain control
4. Acute and chronic pain management

Question 4

Contra-indications for regional anaesthesia

Answer 4

1. Uncooperative patient

2. Coagulopathy/bleeding disorders (safe= platelets>75 and INR

Question 5

Types of regional anaesthesia offered to patients

Answer 5

Topical application 
Local infiltration
IV regional (Bier's block)
Peripheral block
Neuraxial/central blockade

Question 6

Advantages of regional anaesthesia

Answer 6

Pre-emptive analgesia (reduced post operative pain)
Less physiologic derangement
Rapid post op recovery
Avoid need for ETT
Avoid complications of GA
Decreased incidence of DVT
Reduced surgical stress response (best when infused for 24-48hours post surgery)

Question 7

Disadvantaged of regional anaesthesia

Answer 7

Patient might prefer GA
Skill required
Small failure rate
Time for anaesthesia to become fully effective
Risk of systemic toxicity

Question 8

Types of topical anaesthetics

Answer 8

Aerosolised (2-4% Lignocaine in MacIntosh sprayer to numb larynx)
Cream (EMLA/Ametop - skin graft or drip site)
Eye drops

Question 9

When is topical anaesthetic used

Answer 9

Minor eye surgery
Laryng- or bronch- oscopy
Drain tonsillar abscess
Cystoscopy
Venepuncture or skin graft sites

Question 10

Which drug is used for a Bier’s block

Answer 10

Lignocaine

Question 11

What is the dosage for a Bier’s block

Answer 11

0.5% Lignocaine (30-40ml)

Question 12

How is a Bier’s block performed

Answer 12

• Ensure adequate monitoring
• Place small IV line as distally as possible
• Put up IV line in other limb (if needed for sedation/resus)
• Inflate tourniquet above diastolic pressure
• Slowly inject 30-40ml of 0.5% lignocaine
• Wait 5-10mins
• Use two tourniquets so one can be released when gets too painful
• slowly release the tourniquet
• Never release tourniquet less than 20mins after injecting lignocaine

Question 13

Which two devices can help with the placement of peripheral nerve blocks?

Answer 13

PNS

Ultrasound

Question 14

Common peripheral nerve blocks

Answer 14

Digital ring block
Wrist block
Intercostal block
Intraorbital
Femoral/sciatic
Ilioinguinal

Question 15

Common plexus blocks

Answer 15

Brachial

Lumbosacral

Question 16

Three types of Neuraxial blocks

Answer 16

Epidural
Spinal
Caudal

Question 17

What is the dermatomal pattern of differential block in neuraxial blocks?

Answer 17

Sympathetic block two dermatomes higher than sensory block which is two dermatomes higher than motor block.

Question 18

Layers the needle penetrates when giving a spinal

Answer 18

Skin
Subcut tissue
Supraspinous ligament
Intraspinous ligament 
Ligamentum flavum
(epidural space)
Dura mater

Question 19

ABSOLUTE contraindications for neuraxial block

Answer 19

Local infection
Coagulopathy/ anticoagulation
Shock/ severe hypovolaemia
Increased ICP
Fixed cardiac output states
Allergy
Patient refusal

Question 20

RELATIVE contraindications for neuraxial block

Answer 20

Sepsis
Uncooperative patient
Pre-existing neural disease
Spinal deformity
Prior back surgery
Complicated surgery