Zero to Finals: Other Types of Anaesthesia

Question 1

What type of anaestehsia is peripheral nerve block?

Peripheral nerve block

Answer 1

Regional anaesthesia
* patient remains awake during the procedure

Question 2

How is peripheral nerve block carried out?

Peripheral nerve block

Answer 2

• Patient remains awake during the procedure
• Local anaesthetic injected around specific nerves, causing the area distal to the nerves to be anaesthetised (usually involves making a limb numb so that a surgeon can operate without causing any pain)
• A screen is put up between the patient and the operating site so that they cannot see the operation taking place.

Injection is performed under ultrasound guidance, sometimes with the help of a nerve stimulator, so that it can be accurately applied to the area around the targeted nerve.

Question 3

What is Central neuraxial anaesthesia?

Central Neuraxial Anaesthesia

Answer 3

Regional anaesthesia

Also known as spinal anaesthetic or spinal block

Question 4

When is spinal block most commonly used?

Central Neuraxial Anaesthesia

Answer 4

• Caesarean sections
• Transurethral resection of the prostate (TURP)
• Hip fracture repairs

The patient remains awake during the procedure.

Question 5

How is a spinal block procedure carried out?

Central Neuraxial Anaesthesia

Answer 5

• The patient remains awake during the procedure
• A local anaesthetic is injected into the cerebrospinal fluid, within the subarachnoid space (only used in the lumbar spine)
• Cold spray applied to the skin is often used to test whether the anaesthetic has worked

Question 6

Why is spinal block carried out only in lumbar spine area?

Central Neuraxial Anaesthesia

Answer 6

To avoid damaging the spinal cord (inserted into the L3/4 or L4/5 spaces)

Question 7

What is the effect of Central Neuraxial Anaesthesia?

Central Neuraxial Anaesthesia

Answer 7

Numbness and paralysis of the areas innervated by the spinal nerves below the level of the injection

Question 8

How long for Central Neuraxial Anaesthesia to wear off?

Answer 8

1-3 hours

Question 9

When is epidural anaesthesia most commonly used?

Epidural Anaesthesia

Answer 9

• Analgesia in pregnant women in labour
• Post-operatively after a laparotomy (open abdominal surgery)

Question 10

How is an epidural procedure carried out?

Epidural Anaesthesia

Answer 10

• A small tube (catheter) is inserted into the epidural space in the lower back (outside the dura mater, separate from the spinal cord and CSF)
• Local anaesthetic medications are infused through the catheter into the epidural space, where they diffuse to the surrounding tissues and spinal nerve roots, where they have an analgesic effect

Question 11

What agents are used for epidural anaesthetic procedures?

Epidural Anaesthesia

Answer 11

**Levobupivacaine ** (with or without fentanyl)

Question 12

What are some adverse ffects of epidural anaesthesia?

Epidural Anaesthesia

Answer 12

• Headache (if the dura is punctured, creating a hole for CSF to leak from (“dural tap”))
• Hypotension
• Motor weakness in the legs
• Nerve damage (rare)
• Infection (e.g. meningitis)
• Haematoma (may cause spinal cord compression)

Patients need an urgent anaesthetic review if they develop significant motor weakness (unable to straight leg raise). The catheter may be incorrectly sited in the subarachnoid space (and cerebrospinal fluid) rather than the epidural space.

Question 13

What are risks of useing analgesia in labour?

Epidural Anaesthesia

Answer 13

• Prolonged second stage
• Increased probability of instrumental delivery

Question 14

What is the effect of local anaesthesia?

Local Anaesthesia

Answer 14

To numb a very specific area where a procedure is being performed

Question 15

When are local anaesthetics used?

Answer 15

Smaller operations and procedures

Question 16

What agents are used for local anaesthesia?

Local Anaesthesia

Answer 16

• Lidocaine(amide)
• Cocain (salt, cocaine hydrochloride)
• Bupivacaine
• Prilocaine

Usually injected by the person performing the procedure (rather than involving an anaesthetist)

Question 17

What procedures are commonly performed under local anaesthetic?

Local Anaesthesia

Answer 17

• Skin sutures in A&E after a skin laceration
• Minor surgery to remove skin lesions
• Dental procedures
• Hand surgery (e.g., carpal tunnel syndrome surgery)
• Performing a lumbar puncture
• Inserting a central line
• Percutaneous procedures (e.g., percutaneous coronary intervention)