HWN Suggests

The Building Blocks of Regional Anesthesia

We need to start pushing for the widespread use of regional anesthesia, so more patients have access to it. Creating a deliberate strategy of standardizing a small number of versatile, high-value nerve blocks is what will transform regional anesthesia from a niche subspecialty delivered by and for a few into a mainstream practice performed and received by many. Making competency in even a basic set of blocks the norm won't happen overnight. Training must evolve.

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Articles of Interest

Regional Anesthesia for Hip Fractures

There are many anesthetics to choose from, but the best anesthetics to use in the case of an acute hip injury are long-acting. Always ensure that you correct for the patient’s weight when choosing an anesthetic and determining volume.

Regional Anesthesia & Acute Pain Management in the Emergency Department

Regional and local anesthesia is particularly well suited to the ED, where many patients present with acute, localized painful injuries that are amenable to a short-term, selective peripheral blockade.

Regional Anesthesia and Pain Medicine Specialists Should Not Help Train Nonanesthesia Specialists to Perform Peripheral Nerve Blocks

The provision of regional anesthesia by nonanesthesiologists has been the subject of growing discussion. Emergency medicine (EM) and intensive care unit physicians are well positioned to learn ultrasound-guided procedural skills because of their regular use of ultrasound for focused assessment of trauma, vascular access and cardiac evaluation. However, we are still determining the best way to teach and assess competence in regional anesthesia.

Regional anesthesia in Canadian emergency departments: Emergency physician practices, perspectives, and barriers to use

Canadian emergency physicians use regional anesthesia infrequently but express an interest in expanding their use. While equipment is available, additional training, protocols, and increased support from nursing staff are modifiable factors that could facilitate uptake.

Regional Anesthesia in Patients with Trauma

Regional anesthetic techniques, and peripheral nerve blocks in particular, provide high-quality analgesia that is site specific and devoid of any systemic (especially opioid-related) side effects. Regional anesthesia may also confer several other advantages over systemic analgesic therapies for trauma patients, including decreased length of stay in the emergency department and critical care unit, improved ability to perform neurologic assessments, improved comfort and safety for transport, and cost savings compared to procedural sedation.

Regional anesthesia in the emergency department outside the operating theatre

Moderate to severe pain is common and remains a significant problem in the emergency department and regional anesthesia provides optimal and safe pain relief. This review aims to discuss the benefits, indications of the most common ultrasound-guided regional anesthesia techniques that can be provided by clinicians in the emergency department as part of multimodal analgesia.

What are Regional Blocks?

Peripheral nerve blocks, or regional blocks, are crucial to clinical acute pain management. These techniques block nerves along a body’s neural path, rendering individual body parts and regions painless and, sometimes, temporarily immobile. Regional blocks help to provide excellent pain management after a patient has come out of general anesthesia.

Resources

7 Regional Anesthesia Questions

We invited a member of our editorial advisory board, Admir Hadzic, MD, PhD, to select a group of international experts and ask them seven questions of his own choosing. (Note that not everyone answered all of the questions.)

Posterior Tibial Block

The reason I love this block: The bottom of the foot is sensitive and impossible to effectively achieve adequate pain control without using this block. This block is perfect for complex lacerations or foreign bodies in the sole of the foot. The first time I used this block it was for a patient who had injured their foot on coral. The repair required a lot of irrigation, foreign body removal, and complex wound repair.

Taming the SRU

For your basic blocks you will need...

JAMA

Regional anesthesia makes a specific part of the body numb to relieve pain or allow surgical procedures to be done. Types of regional anesthesia include spinal anesthesia (also called subarachnoid block), epidural anesthesia, and nerve blocks.

StatPearls

Regional anesthesia consists of infiltrating a peripheral nerve with an anesthetic agent and blocking transmission to avoid or relieve pain. It differs from general anesthesia as it does not affect the patient's consciousness level to relieve pain. There are several advantages over general anesthesia, such as avoidance of airway manipulation, reduced doses...