Regional Anaesthesia

               Regional Anaesthesia

"Never stand when you can sit, never sit when you can lay down"

Introduction:

 

    Regional anaesthesia is used to numb only the portion of the body which will recover the surgical procedure.

Unlike general anesthesia patients may remain awake during the procedure, resulting in reduced side effects.

Types of regional anesthesia:

• Spinal anaesthesia: Involves injecting a local anesthetic into the spinal fluid. Once injected, the medicine mixes with spinal fluid in the lower back and numbs the nerves, effectively blocking sensation and pain. Used for any surgery occuring below the rib cage (Eg: surgery on the lower abdomen and legs)
• Epidural anaesthesia: Involves placement of a catheter into the epidural space, with the help of an epidural needle. Depending on the nerves targeted the epidural can be placed in various region of the back from neck to the sacrum. Epidural medications can be given through this catheter to provide numbness for the surgery and also can be used to provide pain relief in the post operative period.
• Nerve block: Often a group of nerves, called a plexus or ganglion, that causes pain to a specific organ or body region can be blocked with local anesthetics. Anesthetists use a variety of nerve blocks to ensure comfort throughout a surgical procedure.

Nerve blocks and body part associated:

• Trigeminal nerve block- Face
• Ophthalmic nerve block- Eyelids and scalp
• Supra orbital nerve block- Forehead
• Maxillary nerve block- Upper jaw
• Sphenopalatine nerve block- Nose and palate
• Brachial plexus block- Shoulder, arm and hand
• Subarachnoid block and celiac plexus block- Abdomen and pelvis

Uses of regional anaesthesia: Commonly used for orthopedic, obstetric and dental procedures

Side- effects of regional anaesthesia:

1. Pain and tenderness around the injection site.
2. Bleeding from the injection site
3. Hematoma
4. Spinal Headache
5. Hypotension
6. Nerve damage
7. Medications mistakenly injected into a vein - causing dizziness, rapid heart beat, and funny taste or numbness around the mouth
8. Horner's syndrome 

Medications used in regional anaesthesia:
    Common anesthetics used are 

1. Novacaine
2. Bupivacaine
3. Lidocaine
4. Proparacaine

Nurse's Interventions:

 Pre-anaesthetic care:

1. Monitor vitals
2. Assess any history of allergies to medicine or any other substances
3. Monitor the blood results
4. Obtain informed consent
5. Explain to the patient and relatives regarding the procedure and the anesthesia used
6. Administer pre-anaesthetic medications and Iv fluids as prescribed
7. Valuables such as jewelry should be removed for safe keeping
8. Ask the patient to remove prosthesis such as dentures,contact lenses or artificial limbs.
9. Maintain NPO status from midnight

Note: Vitals include respiratory rate, O2 saturation, pulse rate, blood pressure, bleeding, conscious state, sedation score, pain score, and temperature.

Post - anesthetic care:

• Monitor vitals and intake -output chart
• Monitor for any complications
• Administer medications (analgesics, antiemetic, IV fluids) as prescribed
• Assess the level of sensation after regional anesthesia
• Once stable patient is shifted from post anesthetic care unit