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Risk of Regional Anesthesia

Risk of Regional Anesthesia. Assist. Prof.Surirat Sriswasdi Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University 12 October 2005. Regional Anesthesia. Peripheral nerve block Plexus block Neuraxial block. Advantage. Less stress response

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Risk of Regional Anesthesia

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  1. Risk of Regional Anesthesia Assist. Prof.Surirat Sriswasdi Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University 12 October 2005

  2. Regional Anesthesia • Peripheral nerve block • Plexus block • Neuraxial block

  3. Advantage • Less stress response • Provide postoperative pain • Early ambulation

  4. Local Anesthetic Agents • Lidocaine • Bupivacaine • Ropivacaine • Levobupivacaine

  5. Local Anesthetics Toxicity • Tissue toxicity • Systemic toxicity • - Central • - Cardiovascular

  6. Central Nervous System Toxicity • Metallic taste • Light headeness • Tinnitus • Visual disturbance • Numbness of tongue & lips

  7. Central Nervous System Toxicity (cont.) • Muscle twitching • Loss of consciousness • Grand mal seizures • Coma

  8. Treatment • Stop injection • Administration O2 • Anticonvulsant • Maintain airway

  9. Cardiovascular toxicity • Ventricular contractility • Refractory cardiac arrhythmia • Loss of peripheral vascular tone

  10. Treatment • Oxygen • Fluid • Vasopressor • Amiodarone • Prolonged cardiopulmonary • resuscitation

  11. Plexus Blockade • Interscalene block • - Ipsilateral phrenic nerve • block (100%)

  12. Plexus Blockade (cont.) • Supraclavicular block • - Pneumothorax • (0.5-0.6%)

  13. Plexus Blockade (cont.) • Bier’s block • - Tourniquet failure • (systemic toxicity)

  14. Neuraxial Block • Spinal block • Epidural block

  15. Spinal Block • Intraoperative complication • - Hypotension • - Bradycardia • - Nausea / vomiting • - Dyspnea • - Bezold Jarisch reflex (severe • bradycardia - hypotension)

  16. Spinal Block (cont.) • Postoperative complication • - Urinary retention • - Post dural puncture headache • Neurological impairment • Transient radicular irritation ( TRI) • Transient neurological syndrome (TNS) • - Infection • - Backache

  17. TRI / TNS • Subarachnoid injection • 5% lidocaine • Less with bupivacaine • Lithotomy position increase risk • Chloroprocaine • - Sensory deficit • - Motor deficit

  18. Epidural Block • Intraoperative complication • - Unintentional dural puncture • - Subarachnoid injection • - Intravascular injection • - Local anesthetic overdose

  19. Epidural Block (cont.) • Postoperative complication • - Direct spinal cord injury • - Hematoma • - Infection

  20. Epidural Block with Catheter • Catheter problem • - Insert into epidural vein • - Break off or become knotted • - Cannulation subarachnoid space • - Infection

  21. Thank You

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