why i do (some) blocks under general anaesthesia?
Post on 28-Jul-2015
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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
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
Patient fears about regional anesthesia?
• Pain during the block• Pain in the operating room• Being awake for surgery• Failure of the block
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)
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
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