Indications#

Indications for Regional Anesthesia#

  • To avoid inducing general anesthesia, which can cause significant hemodynamic/cardiac & pulmonary consequences.

  • To avoid intubation

  • Analgesia without affecting neurologic status

  • Superior intraoperative & post-operative analgesia compared to IV alone

  • Childbirth/Labor Analgesia. Avoid delivering controlled substances to fetus/newborn.

Primary vs. Adjunctive vs. Analgesic#

Primary Regional Anesthetic

Regional + General

Analgesic

What

OR: Sole anesthetic & analgesic for surgery, confined to nerve distribution

OR: Regional for analgesia & blunt surgical stimulus, but patient still needs intubation

Pain control for post-op/floor/ICU patients.

Example

Hand/Wrist Surgery, Cesarean Section

Thoracotomy, Nephrectomy, Burns Skin Grafting

Rib fractures in frail patient, Rescue Blocks in PACU

Nerve vs. Plane Block#

Nerve Block: injection or catheter right next to nerve.

  • Often needed for primary regional blocks

  • Low-volume blocks

Plane Block: injection or catheter at fascial plane.

  • Spread of local anesthetic eventually reaches target nerves which pass through fascial plane

  • Often analgesic blocks

  • High volume, low concentration blocks

When/Where We Do It#

Location/Timing

Description

Pre-induction

Most blocks. Usually in PACU by Block Team, sometimes in OR.

  • Patients can be sedated, but are awake to provide feedback
  • Minimizes needle injuries & intraneural injections.
  • Patients can cooperate with specific positioning
  • Blocks provide intra-operative analgesia

    		•

    Post-induction

    Only if patients already intubated, or cannot tolerate procedure awake (e.g. pediatrics)

  • No patient feedback
  • Limited patient positioning

    		•

    Pre-emergence

    Often for skin graft donor site, unknown location/extent of graft harvest pre-operatively

    Post-emergence

    Rescue block. If pain not controlled in PACU with IV analgesics.

    ICU

    commonly Erector Spinae Block (ESP) or Serratus Anterior for frail rib fracture/surgery

  • analgesia for broken ribs to assist with tidal volumes & extubation

    		•

    Floor

    patient needs to be transported to PACU for procedural monitoring