Why I do (some) blocks under general anaesthesia?

1

Pro: I do perform nerve blocks in anaesthetized

patients

Colin J.L. McCartney MBChB PhD FRCA FCARCSI FRCPC

Head of AnaesthesiaThe Ottawa Hospital,

Professor and Chair of AnaesthesiaUniversity of Ottawa, ON, Canada

Conflicts of Interest

• None

Definition of Anaesthesia

an·es·the·siaˌanəsˈTHēZHə/nounnoun: anaesthesia; noun: anesthesiainsensitivity to pain, especially as artificially induced by the administration of gases or the injection of drugs before surgical operations.

Regional Anaesthesia

• no-brain·er (nō brā nər)′ ′• n. Informal• Something, especially a choice or decision,

that is so obvious or easy as to require little or no thought.

Benefits of RA• Reduced pain• Reduced nausea• Faster discharge• Faster return of GI function• Improved rehabilitation• Reduced respiratory complications• Reduced MI and CVS complications• etc etc

Cepeda et al A&A 2005

Insert recent RA meta-analysis

Richman JL et al A&A 2006

Continuous RA vs Opioid:

Regional Anesthesia and Impact on Perioperative Medicine

Memtsoudis SG RAPM 2013

Patient Opinion of Regional Anesthesia?

Patient fears about regional anesthesia?

• Pain during the block• Pain in the operating room• Being awake for surgery• Failure of the block

Patients opinions regarding RA

Overcoming fears

• Reassurance about sedation/anaesthesia during block performance

• Proper informed consent• Use of all modalities to avoid risk of nerve

injury (stimulation, injection pressure, ultrasound guidance etc)

Special populations

• Children

• Trauma

Paediatric regional anaesthesia

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What do we fear about doing blocks on asleep patients?

Recognize causes of nerve injury and balance risks

• Patient, Surgical and Anaesthesia related factors

• Appropriate and documented informed consent

• Recognize contribution of tourniquet and other surgical causes

• More proximal blocks ? Higher risk

Don’t do stupid stuff:

Get Practice

Kathy Sierra: http://headrush.typepad.com/creating_passionate_users/2006/03/how_to_be_an_ex.html

J Shoulder Elbow Surgery 2007; 16 (Jul/Aug): 379-387

Follow up with your patient

Yes-I do blocks in asleep patients

• Not all blocks• Most blocks deeply sedated• Some blocks on anaesthetized patients:

specific populations• Good informed consent, careful technique

and follow up essential for all regional anaesthesia