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Anesthetics > Regional Anesthesia > Flashcards

Regional Anesthesia Flashcards

1
Q

Order of disappearance of function

A
  • C fibres - dull pain, warmth, preganglionic autonomic
  • B fibres - postganglionic autonomic
  • Aδ fibres - sharp pain and cold
  • Aγ fibres - proprioception
  • Aβ fibres - touch and pressure
  • Aα fibres - motor and position sense
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2
Q

Sedation

A
  • Fentanyl 50-100μg IVI
  • Midazolam 1-2mg IVI
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3
Q

Identification of nerve site

A
  • Anatomical landmarks
  • Eliciting paraesthesia
  • Electrical stimulation
  • Ultrasound
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4
Q

Central Neuraxial Block - Contraindications

A

Absolute:

  • Local infection
  • Severe hypovolemia
  • Coagulopathy
  • Anticoagulation
  • Antiplatelet drugs
  • Raised ICP
  • Patient refusal
  • Fixed cardiac output
  • Allergy to LA

Relative

  • Psychosis or dementia
  • NSAIDs
  • Prolonged surgery, or uncertain of duration
  • Surgical team resistance
  • Septicemia
  • Spinal column disease
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5
Q
A

Quincke-Babcock (cutting spinal needle)

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6
Q
A

Whitacre (splitting spinal needle)

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7
Q

Spinal Anesthetic - Procedure

A
  • Establish IV access and preload 500ml crystalloid or 200-300ml colloid
  • Attach monitors, set NIBP to 1 minute interval readings
  • Position patient - sitting or lateral decubitus
  • Scrub, mask and gown
  • Locate the L3/4 intervertebral space (space closest to a line joiing the iliac crests)
  • Inject 5ml 1-2% lignocaine into skin & SC tissue
  • Insert spinal needle in the midline with a 15 degree cephaloid angulation
  • Advance slowly until a slight pop is felt (4-6cm)
  • Check for free back flow of CSF
  • Slowly inject desired amount of LA
  • Position patient appropriately for desired block
  • Monitor patient closely, especially for the first 15-20 minutes (NB patient communication)
  • Check and document sensory level of block
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8
Q

Spinal Anesthetic - Sensory Levels

A
  • T4-T5 - nipple Line
  • T6-T8 - xiphoid
  • T10 - umbilicus
  • L1 - inguinal ligament
  • L2-L3 - knee and below
  • S2-S5 - perineum
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9
Q

Spinal Anesthetic - Doses (General)

A

Lignocaine

  • 1-3ml 1-2%
  • 5-10 min onset
  • 30-90 min duration

Bupivacaine

  • 2-5ml 0.5%
  • 10-20 min onset
  • 100-240 min duration
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10
Q

Spinal Anesthetic - Doses (Specific)

A
  • T6-T10: 2.5-3ml heavy bupivacaine, supine position
  • T11-L1: 2.5ml heavy bupivacaine or 2.5-3ml plain bupivacaine or levobupivacaine
  • L2-L5: 2ml heavy bupivacaine or 2.5ml plain bupivacaine or levobupivacaine
  • S1-S5: 1-1.5ml heavy bupivacaine, sitting position
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11
Q
A

Tuohy Epidural Needle

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12
Q

Epidural Anesthetic - Procedure

A
  • Infiltrate skin and SC with LA
  • Insert Tuohy needle through skin and superficial fascia
  • Remove stylet, and attach syringe with saline
  • advance needle slowly, bouncing needle plunger
  • Advance needle into epidural space
  • Remove needle, and observe for blood or CSF backflow
  • Insert teflon catheter into epidural space
  • Withdraw needle, dress wound, and strap catheter in place
  • Test position of catheter - injection of LA with adrenaline
    • Immediate onset of spinal anesthesia - subarachnoid space
    • Tachycardia and hypertension - blood vessel
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13
Q

Epidural Anesthetic - Doses

A

Lignocaine

  • 15-30ml 1-2%
  • 5-10 min onset
  • 30-90 min duration

Bupivacaine

  • 10-20ml 0.25-0.75%
  • 10-20 min onset
  • 100-240 min duration
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14
Q

Caudal Block (Dosage)

A

1-2ml/kg 0.25% bupivacaine

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15
Q

Epidural vs Spinal

A

Epidural:

  • More motor sparing
  • Spare lower limbs
  • Continuous anaesthesia

Spinal:

  • Cheaper
  • Easier
  • Lower dosage
  • Less painful
  • Denser block
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16
Q

Central Neuraxial Block - Side Effects

A
  • Hypotension (sympathetic blockade) - preload patient, treat with fluids and sympathomimetics if necessary
  • High spinal (hypotension, bradycardia, and respiratory insufficiency) - avoid with slow injection, appropriate dosing, and careful positioning, supportive treatment
  • Spinal headache (CSF leak)- avoid with smaller needles, treat with bedrest, IV fluids, analgesics, caffeine, or epidural blood patch
  • Hematoma (backache and rapidly progressive neurological deficit) - evacuation
  • Epidural abscess (backache, fever, raised WCC) - surgical evacuation
  • Nerve trauma (pain or paraesthesia on needle insertion) - recovery within 3 months
17
Q

Peripheral Nerve Block - Dose

A

Bupivacaine

  • 5-70ml (0.25%)
  • 5-37.5ml (0.5%)
  • 10-15 min onset
  • 180-360 min duration (240-480 with adrenaline)
18
Q

Plexus Block

A

Lignocaine

  • 15-50ml 1-2%
  • 10-20 min onset
  • 90-120 min duration (120-240 with adrenaline)

Bupivacaine - Brachial Plexus

  • 0.3-0.5ml/kg 0.25-0.5%
  • 20-30 min onset
  • 6-15 hour duration (10-20 with adrenaline)

Bupivacaine - Lumbar and Sacral Plexus

  • 0.3-1ml/kg
  • 25-35 min onset
  • 18-24 hour duration

Anesthetics (10 decks)

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