Regional anesthesiaRegional anesthesiaDr.Mohamed DabbourDr.Mohamed DabbourAnaesthesia lecturerAnaesthesia lecturerAin Shams UniversityAin Shams University

Regional anesthesia can be divided into neuraxial blocks and peripheral nerve blocks.

Neuraxial blocks include subarachnoid, epidural and caudal anesthesia.

Neuraxial blocks

Anatomy:-

spinal cord is surrounded by 3 layers:-Pia matter subarachnoid space arachnoid matter subdural space

dura matter epidural space bone.

in the cervical region, the most prominanat spinous process is C7.

The spinal cord ends at the level of L1-L2,while the dural sac usually ends at S2 vertebra.

The spinous processes of the cervical and lumber spine are Horizontal, they are directed caudally in the thoracic region. (1)

The intercrestal line (between both iliac crests) usually crosses either body of L4 or L4-5 interspace. This is called Tuffier’s line.

The inferior angle of the scapula is at the same level of spinous process of T7

Indications for neuroaxial block

Any surgeries below the umbilicus.

Surgeries above the umbilicus. (1)

It has many advantages both medically wise and surgically wise and for postoperative pain control.

Contraindications of neuraxial blocks:-

absolute:-

lack of consent.

Coagulopathy and anticoagulation therapy.

Bacteremia and skin infection at the site of injection.

Hypovolemia and shock.

Demyelinating CNS disease.

Severe aortic and mitral stenosis.

Relative :-

Minidose heparine, aspirin…..etc.

Prior spine surgery or back pain.

Respiratory failure, especially if high block is required.

Increases intracranial tension

Some cardiac lesions.

How to prepare the patient:-

Informed consent.

History taking and physical examination.

Laboratory testing including CBC and coagulation profile.

Premedicate and preload.

Safety issues:- Monitors; ECG, NIBP, and pulse oximetry

Resuscitaion equipment; G.A. and an anesthesia machine have to be available .

Needles:- Needles differ according to their bevel.

Bevel may be blunt edge, or sharp edge. (1) Short, medium or long length.

We have a tuohy needle, used for epidural.

Techniques:-

Positioning the patient: sitting, lateral or prone. (1)

Identification of the anatomic land marks. (2)

Asepsis: of the anesthesiologist and the patient. (1)

Infiltrations of local anesthetic.

Needle introduction:- either median or paramedian, with the bevel facing lateral. (2)

Different techniques in spinal and epidural.

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