Mod IV: Regional Anesthesia Part 6

Question 1

_{Regional Anesthesia - Single Shot – vs – Catheter}

Single Shot:

Answer 1

Easier to perform

Fewer risks

Effects generally limited <24 Hrs

Question 2

_{Regional Anesthesia - Single Shot – vs – Catheter}

Continuous Perineural Catheter:

Answer 2

More Difficult to perform and maintain than SS

Question 3

_{Regional Anesthesia - Single Shot – vs – Catheter}

Risks of Continuous Perineural Catheter:

Answer 3

Infection

Leaking

Dislodgement/migration

Knotting and kinking

Neural injury

Equipment goes home with Pt

Pt selection critical

Question 4

_{Regional Anesthesia - Single Shot – vs – Catheter}

Benefits of Continuous Perineural Catheter:

Answer 4

Longer/better pain control

^{Can remain in up to 72hrs}

^{Facilitates early dicharge}

Reduce narcotic use

^{Also reduced side effects of narcotics}

Improved PT satisfaction

^{Will play big part in future reimbursement}

Allows more invasive procedures to be outpatient!!!

Question 5

_{Regional Anesthesia - Single Shot – vs – Catheter}

Placement of Continuous Perineural Catheter:

Answer 5

With or without US

Stimulating catheters

Stimulating Tuohy

Question 6

_{Regional Anesthesia - Single Shot – vs – Catheter}

Continuous Perineural Catheter - Catheters can be:

Answer 6

Stimulating

Wire wound

Curled

Over-the-needle type

Question 7

_{Regional Anesthesia - Single Shot – vs – Catheter}

Continuous Perineural Catheter - Catheter placement and use varies with location - Femoral Associated with:

Answer 7

Quad weakness and falls

Adductor Canal being used more frequently

Question 8

Tuohy Needle and catheter

Answer 8

Tuohy Needle and catheter

Question 9

Catheter over needle

Answer 9

Catheter over needle

Question 10

_{Local Anesthetic Pumps}

Electric Pumps

Answer 10

Electric Pumps

Question 11

_{Local Anesthetic Pumps}

Mechanical Pumps

Answer 11

Mechanical Pumps

Question 12

_{Getting Ready to perform a block}

Equipment used to perform Block - Block Room

Answer 12

If you are so lucky…

Question 13

_{Equipment used to perform Block}

Block Cart - Should contain:

Answer 13

All supplies needed to perform block start to finish

Eliminate running for supplies

Question 14

_{Equipment used to perform Block}

Pt Monitoring:

Answer 14

Standard monitors

Question 15

_{Equipment used to perform Block}

Other Equipment:

Answer 15

US Machine

Nerve stimulator

Injection Pressure monitor

Set-up will vary depending on how block placed and type of block

Question 16

_{Equipment used to perform Block}

Have a Basic Set up:

Answer 16

4x4’s - Tape - Towel

NC/Mask - Sedation Meds

Skin Prep

^{Chlorhexadine}

Skin Anesthetic

^{3ml syringe, 25ga needle - 1-2% Lidocaine}

Block Needle

^{Size? - Stimulating? - Echogenic?}

Block Syringes

^{Volume? - LA Selection - Additives}

Question 17

_{Equipment used to perform Block}

Block Tray:

Answer 17

Standard and Custom

^{Can include anything you want}

Single shot and catheter trays

Great for grab and go

Expensive

Question 18

_{Equipment used to perform Block}

Setting up for a block:

Answer 18

Basic Setup set

^{Single Shot vs Continuous Catheter}

Nerve stimulator

^{Stimulating needle - ECG Sticker}

Ultra Sound Machine

^{US Jelly - Printer or image capture}

^{Pt entered into machine - Transducer cover}

^{Darken room}

Position Pt

Position Yourself and Equipment

Having help is a must

Perform safest Block Possible

Question 19

_{Equipment used to perform Block}

Triad of Safety:

Answer 19

1. Nerve Stimulator
2. Injection Monitoring

^{Pressure - Pain/Paresthesia}

3. Ultrasound Guidance

Question 20

_{Regional Anesthesia}

Reference Links:

Answer 20

www. cambridgeorthopaedics.com
www. blockjocks.com
www. ncbi.nlm.nih.gov/pubmed
www. nysora.com
www. neuraxiom.com
www. usra.ca
www. ultrasoundblock.com