Regional anesthesia; A quick introduction
Submitted by Kelli Warns RN BSN
You have nerves that run all through your body. Nerves provide a pathway for impulses to communicate between the brain and other parts of your body. Not only do your nerves tell your muscles to move, they tell your brain when something is painful.
Regional anesthesia or “nerve blocks” is a highly effective form of anesthesia where only a specific part of your body is anesthetized. It is a way to “turn off” pain signals in a specific area of the body. The benefits of regional anesthesia are numerous and go beyond the avoidance of risks associated with general anesthesia. Primarily the best benefit is the elimination of pain during and after surgery. Blocks can be done either as a single shot injection or may have a catheter placed with a continuous infusion of local anesthesia. Regional anesthesia results in less nausea, patients awaken faster, have better pain control, have earlier recovery of bowel function, require less narcotics, and have easier participation in physical therapy. Most regional anesthesia patients are orthopedic patients, however regional anesthesia can be provided for cardiothoracic, pancreatic-biliary, vascular, urology, and other disciplines of surgery as appropriate.
There are three types of regional anesthesia; neuraxial, perineural, and paraverterbral. Neuraxial includes epidurals, continuous and single shot spinals, and spinal drains. Perineural, which is femoral, sciatic, popliteal, saphenous and infra/supraclavicular. Paravertebral includes cervical, thoracic and lumbar. All of these blocks can be done as a single shot injection or may have a catheter placed with continuous infusion of local anesthetic. Ropivacaine 0.5% is the usual medication used for bolus while Ropivaciane 0.2% or 0.1% is the concentration for continuous infusion.
A possible and emergent complication that can arise during placement of regional anesthesia is lidocaine toxicity. Local anesthetic systemic toxicity (LAST) is potentially life threatening. Signs and symptoms of LAST include sudden alteration in mental status, severe agitation or loss of consciousness, circumoral numbness, facial tingling, restlessness, vertigo, tinnitus, slurred speech and seizures. The treatment is to maintain the airway of the patient and administer lipid emulsion therapy immediately.
Single shot nerve blocks can last between 12 to 20 hours. The affected extremity may be weak or difficult for the patient to control during this time. It is important to educate a patient about protecting the extremity involved with regional anesthesia. As the numbness wears off, the patient may feel tingling as the nerves start to wake up.
Risks and potential complications are rare, but can include failure to relieve pain, bleeding, bruising, infection at the injection site, and damage to nerves. Allergy to the medications used can also be a complication to regional anesthesia.
Understanding the concept of regional anesthesia with assist nurses in practicing up to date knowledgeable skills that can be utilized in every day practice as a professional nurse.