Dr Azrin Mohd Azidin

MBBS M Med (Anaes), A M

Dept of Anaesthesia and Intensive Care

Hospital Kuala Lumpur

Content

Overview on Regional Anaesthesia

History

Techniques

Single injection & Continuous

Why Do Regional and its Role

Literature Review

Future

Conclusion

a method of anaesthetic administration that provide sensory and motor and/or autonomic system blockade that affect certain anatomical parts, as a sole anaesthetic method or in combination with general anaesthesia, to provide (post operative) pain relief.

Central Neuraxial Block

Peripheral Nerve Block

Truncal Block Plexus Block

Individual Nerves

Field Block

Infiltration

1846: William T.G. Morton- public demonstration of ether anaesthesia

1884: Hall- injection of cocaine into forearm; Halsted-direct injection of nerve trunks

1892: Carl Schleich- local infiltration

James Leonard Corning (1855-1923)- tourniquet prolongs analgesic effect

Heinrich F. Braun (1862-1934)- adding adrenaline

1911: G. Hirschell- 1st

percutaneous brachial plexus block via axillary approach

1911: D. Kulenkampff (supraclavicular)

1917: L. Bazy & V. Pauchet (infraclavicular)

1970: Alon P. Winnie (interscalene)

1908: August Bier- intravenous RA

1898: August Bier & August Hildebrandt- cocaine spinal anaesthesia

1900: Matas- spinal opioids (morphine)

1960: James B. Gomley- epidural blood patch to treat PDPH

1901: Jean Enthuse Sicard & Fernard Cathelin- cocaine caudal anaesthesia

1921: Fidel Pages- blunt needle; segmental anaesthesia

1939: Achille Mario Dogliotti- saline loss of resistance tech

1947: Manuel Martinez Curbelo- Tuohy needle + catheter

Landmark technique

- paraesthesia

- loss of Resistance

Nerve stimulator technique

Ultrasound technique

Dual Guidance

Excellent anaesthesia /analgesia for limb surgery.

Alternative to GA ; avoids the complications

Adjunct to GA

Site-specific anaesthesia

Supplementary analgesia

Extension to post-operative period

intra-operatively

post-operative analgesia

adjuvants

extended analgesia 48 to 72 hours or longer postoperatively

Used at home in ambulatory surgery patients

Current practice

Single injection Catheter Technique

Clonidine, buprenorphine, dexamethasone and midazolam

Issues whether effect seen is due to local effect or systemic

Evidence only midazolam does have effect on action potential

Potential of adjuvant toxicity. Dexamethasone

Various contradicting studies on cost-effectivenessCandido et al (2010).

Technically more challenging

Secondary failure due to various reasons

Liu SS et al . Anesth Analg 2007; 104: 689-702

Ilfeld et al. Anesth Analg 2011; 113: 904-925

Kehlet et al. Lancet 2006; 367:1618-25

Regional anaesthesiao reduces Pain Scores

o Reduces opioid requirements

o Reduces length of stay

o Improves function

o Patient satisfaction

Almost 440 articles the last 3 years

Deegan et al. Reg Anesth Pain Med 2010; 35:490-495

Exadaktylos et al. Anesthesiology 2006; 105: 660-664

Biki et al. Anesthesiology 2008; 109: 180-187

• Drugs

• LA – liposomal preparation

• Toxins

• Resource/ Equipment

• Ultrasound

• Needles

• Catheters

• Training

• technology to help perform regional blocks

• increased awareness

• definite benefit

• suggestive to be of benefit in reduction of tumour recurrence

prevention to chronic pain

Thank

You

Regional Anesthesia and Pain Medicine

Anesthesia Analgesia

Anesthesiology