Conduct of Local

Anesthesia Technique
And Complications

.Dr . HAYTHAM ZIEN , MD

M.D. Anesthesia and ICU Cairo University

S. specialist of Anesthesia
K.F.U.H
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Advantages of Regional Anesthesia
 Avoid the cardiac
inhibitory effect of GA in
cardiac patients .
 Postop. Analgesia .
 Patient satisfaction .
 Neuromuscular disease .
 Difficult impossible
intubation
 Critically ill patients .
 Ext. operation .
 Embolism prevention .
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 Regional
Anesthesia

Central Neuroaxial Epidural .Peripheral N Local

Plexus block
Spinal Caudal block infilteration

Cervical
Stillate gang
Brachial
Lumbar
Celiac

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 L.A Action
 L.A are Na++ch. Blockers

 Diffuse through the

myeline sheeth block
Na ++ ch.

 Prevent the Na entry

maintain RMP
prevents
depolarization No
Action Potential
propagation
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 Spinal Cord
 Spinal cord extend to
T12-L1 in adult
L3 in pedia.
 Covered with fatty tissue,
v.plexus and meningies .
 Pia Arachinoid Dura
matter
 CSF between Pia – Arach .
 Dural sac extend to filum
terminale
back of S2 in adult
S3 inWWW.SMSO.NET
child
 Physiology of neuroaxial block
 Somatic Block
L.A block Na ch. Prevent the action potential
propagation
depend on : Fibre size Myelinated or not
Drug Conc. Duration
 Symp. Block 2 segments above
loss of Temp (Autonomic ) .

Sensory block 2 seg above
loss of pain and light touch .
 Motor block loss of motor and
properioceptive

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 Symp. outflow
thoracolumbar T1 – L2 .

 Parasymp. outflow
craniosacral .

 Neuroaxial Block

block
sympathetic .
↑↑ parasymp. WWW.SMSO.NET
Successful Spinal Block

Autono

Temp
Pain touch
Sensory
Motor

Properioceptive

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 Physiological Effects
 CVS
T1- T4 block cardiac symp.
supply
Parasymp. Predominant ↓↓
HR ↓↓ Contractility ↓ CO
T5-L5 block symp Vascular
supply
VD
↓↓ VR ↓↓ CO ↓↓ BP
 treated by
preload IV fluid 10-20ml/kg
Positioning
Vasopressors WWW.SMSO.NET
 Resp
High block may block the
accessory respiratory Ms.
Intercostals
Total High spinal may
block C4-5
Diaphragmatic (phrenic
nerve).
 Apnea may devlop with
high blocks due to
↓↓ CO ↓↓ BP
↓↓ medullary Bl. Flow
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 Spinal Block
 Midline app.
Skin
Subcutaneous tissue
Supraspinous lig
Interspinous lig
Ligamntum Flvum
Dura matter
Aracinoid matter
 paramedian approach
Skin S.C
Lumbar apeneurosis
lumbar Ms .
Lig. Flavum
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 Spinal Block
 Rapid onset .
 Intense Block .
 Easy tech .
 Low L.A dose required .
 Smaller the gauge the lower
P.D.P.H ( G23 –G 25 ) .

 More hypotensive more CVS effect .

 Shorter duration ( 2 -3 hr )
 Inability to extend the duration .

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 Epidural Anesthesia
 Should not puncture dura
high incidence of PDPH
 Slower onset . Acting on myelinated
nerves .
 Unpredicted block level .
 Difficult tech.
 High failure rate (patchy) .
 High dose of L.A used systemic TOX.

 Catheter prolong the duration .

 72 -96 hr .
 Less hypotensive less CVS effect .
 Postop. analgesia .
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 Complication of Spinal and
Epidural anesthesia
 Hypotension bradycardia .
 Back pain Ms strain .
 Local inflammation .
 Urine retention
 Post Dural puncture headache .
 Total (high )spinal .
 Inadvertent I V injection of L.A.
 Arachinoiditis Meningitis .
 Cauda equina synd.
 Epidural abcess
 Epidural hematoma
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 P.D.P.H
 Frontal headache bilateral
 24 – 72 hr post puncture
 CSF leakage from dural

puncture traction on brain

sensitive structures .
 ppt by :

female > male

Large size needle
 treated by :
rest hot drinks caffeine
analgesics IV Fluids
epidural Bl. patch
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 Contraindication
 Absolute
patient refusal
Coagulopathy
Hemodynamic instability
Hypovol.
Infection
neurological deficit
High CSf pressure
 Relative

Anticoagulant
previous spine operation
psychic time surgeon
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 Brachial Plexus Block
 Indication :
Upper limb
operation
shoulder operation.
Postop. analgesia .

 Approaches
Interscaline

Supraclvicular
Infraclavicular
Axillary

 Disadvantage
Difficult tech.
IV injection
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Brachial Plexus Block

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 IV Regional Anesthesia
Beir’s Block
 In Forearm operation .
 Iv canula inserted .
 Limb evacuated from Bl
 Tourniquet inflated
100mmhg > SBP .
 LA injected
20 -40 ml Lidocaine
2% or prilocaine

 not Bupivacaine !!!!!.

 Deflating after 45 min .

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 Caudal block and others

 Caudal Block
intra and postop analgesia in
pediatric
1ml /kg L.A dose
15-20 ml to fill space

 Ilioinguinal iliohypogastric


Penile block
circumcision

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 Ankle Block
 Indication
Foot surgery
Distal toes .
Depridement in Ð.

 Blocking
Superficial peronial
Deep peronial
Sural
Saphenous
Post. tibial .
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 Specific procedures
 Sup. Laryngeal N.
Block upper airway
instrumentation in
difficult intubation .

 Cervical plexus
Block
Tracheostomy
Thyroidectomy

 Intercostal Block
intraop. And
postop. Analgesia for
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thoracotomies
THANK YOU
DISCUSSION

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