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Local anesthesia
 REGIONAL ANESTHESIA

A regional anesthesia is used when it is

desirable that the patient remain conscious
during the operation.Skeletal muscle
relaxation is usually excellent,especially
with spinal and epidural
snesthesia.Thus,muscle
relaxants(eg,vecuronium)are unnecessary.
 One disadvantage of regional anesthesia is the
occasional failure to produce adequate
anesthesia;another is hypotension due to
sympathetiv blockade.Regional anesthesia is used
most often for surgery of the lower abdomen or
lower extremities,since the effect of sympathetic
blockade of these areas is minimal.
 Nerve Blocks

Nerve blocks are most appropriate for

surgery of the upper extremities.
Interskeletal nerve blocks are useful for
postoperative pain relief. Overall, nerve
blocks play a discomfort they cause the
patient and the time they require.
Local anesthesia agents:
ester procaine (short effect)
and dicaine (long effect)

acetylamine:
lidocaine(medium effect)
bupivacaine(long effect)

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• The incidence of allergic problems, short
shelf-life and brief duration lf action of
procaine have resulted in its infrequent use
at the present time.
 Lignocaine

• Lignocaine is used commonly for infiltration in

concentrations of 0.5-1.0% and for peripheral nerve blocks
if an intermediate duration is required.It can be used for
intravenous regional anaesthesia,although prilocaine is
preferred.Lignocaine 5% has been used for subarachnoid
anaesthesia ,although the degree of action relatively
short.In a concentration of 1-2% ,lignocaine produces
epidural anaesthesia with a short onset time. Lignocaine 2-
4%is used by many anaes-thetists as a topical solution for
anaesthesia of the upper airway prior to awake fibreoptic
intubation.
 Bupivacaine

Bupivacaine0.5% is the most commonly

used drug for subarachnoid anaesthesia in
the UK.It may be used in a plain solution,or
in a hyperbaric formulation.
 Ropivacaine

The cardiovascular toxicity of

bupivacaine has stimulated interest in
finding other long-acting agents which do
not possess this effect.
Common reason:
overdose.
Inadvertent intra-vascular
injection.
The higher blood supply.

Physique is weak.
 Spinal & Epidural Blocks

Spinal anesthesia is achieved by injecting a

local anesthetic into the lumbar intrathecal space.
This blocks the spinal nerve roots and dorsal root
ganglia and probably also blocks the periphery of
the spinal cord. Epidural anesthesia is
accomplished by injecting a local anesthetic into
the extradural (epidural) space. The epidural space
is usually identified via the lumbar approach.
Treatment:
Main support the cardiovascular

and respiratory systems

control convulsions.
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 Resuscitation equipment

• A full range of resuscitative equipment must be in

working order and immediately available. This
includes:
• 1. An anaesthetic breathing system through which
oxygen may be administered under pressure via a
face mask or tracheal tube.
• 2. A laryngoscope with two sizes of blade,a range
of tracheal tubes and an introducer.
• 3.A table which can rapidly be tilted head-down.
• 3.A table which can rapidly be tilted head-
down.
• 4.Suction apparatue.
• 5.Intravenous cannulae and fluids.
• 6.Thiopentone to control convulsions.
• 7.Drugs to treat hypotension, especially
atropine, ephedrine and methoxamine.
• A cannula must be inserted intravenously
before any local anesthetic block is
performed in case emergency therapy is
required.
• Regional anesthesia may be employed with
basic equipment, but some special items
increase the success rate and reduce the risk
of complications.
• Monitoring during anaesthesia
• It is essential to ensure that all monitoring
equipment is maintained correctly and that it
functions accurately, so that the information which
it provides is reliable. The user should understand
the basic principles on which monitoring
equipment is based and be able to interpret the
information provided.
• The anaesthetic record
• Electrocardiography
• Monitoring the circulation
• The peripheral pulse
• Pulse plethysmography
• Pulse oximetry
• Temperature regulation
• Fluid and electrolyte status