SAFETY AND

COMPLICATION
IN REGIONAL
ANESTHESIA
DR RASNADIA ADILA BINTI ROSDI
MEDICAL OFFICER OF
ANESTHESIOLOGY HTM
INTRODUCTION

A regional block is a specific anesthetic technique that

inhibits nerve transmission to avoid or relieve pain

The main types of regional anesthesia are

1.Neuraxial anesthesia (spinal, epidural , caudal)
2.Peripheral nerve blocks
3.Intravenous regional anesthesia (Bier’s Block)
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GENERAL ADVANTAGES
 Avoidance of airway manipulation
 Reduced doses, side effects of systemic
drugs
 Faster recovery time
 Significantly lower pain levels after
surgery
 Can be used in conjunction with general
anesthesia and postprocedural
 Acute and chronic pain conditions
 SPECIFIC BENEFITS
PATIENTS PROVIDERS INSTITUTIONS
 pain Avoid GA Increase OR efficiency
 bleeding /clotting Increased hemodynamic  PACU time
stability
 delirium  airway intervention Increase patient
satisfaction
 sedation  monitoring intensity Increase surgeon
satisfaction
 stress response  opioid usage and side  Cost of treatment
effect
 chronic pain  length of stay and
unplanned admission
 morbidity and mortality logistical requirement
HOW DO YOU PERFORM BLOCK
I INDICATION & CONTRAINDICATION

C CONSENT

S STERILE R AG
L LIGHT SOURCE / ERGONOMICS S L IM
I IV LINE
IC
M MONITOR & USG

R RESUST DRUGS AND EQUIPMENT

A ASSISTANT

G GA EQUIPMENT  CONVERT
INDICATION
6

-No absolute indication for Spinal, Epidural

OR Peripheral Nerve block

-The decision is based on selected situation

(patients and type of surgery)

-Able to weigh the risks and benefits of performing

the procedure
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CONTRAINDICATION

ABSOLUTE RELATIVE
 Active infection at the
The patient's
site of the injection
refusal  Patients with
Allergy to local
coagulopathies
anesthetics  Preexisting neurologic
deficit
 Inability to cooperate
CONSENT
DISCLOSURE
 Risk
 Benefit
 Alternatives
 Time for Questions DISCLOSURE
Not every possible risk should be
CAPACITY mentioned
 Understanding of information provided
 Ability to make a judgement
 Understanding potential consequences Which risks should be discussed ?
 Risk severity
 Risk Frequency
VOLUNTARINESS
 Absence of coercion
Pair risks disclosed with mitigation
strategies
May not be possible in emergency Eg : “There is a risk of infection , but we
use sterile technique, wear masks, hats,
gloves and sterile soap”
HOW DO YOU PERFORM BLOCK
I INDICATION & CONTRAINDICATION 

C CONSENT 

S STERIL  R AG
L LIGHT SOURCE / ERGONOMICS  S L IM
IC
I IV LINE 

M MONITOR & USG

R RESUST DRUGS AND EQUIPMENT

A ASSISTANT

G GA EQUIPMENT  CONVERT
MONITORING
 Ultrasonography
-makes it possible to see the needle in real time and
therefore quickly and more accurately guide the needle
toward the target.

 Monitoring injection pressure

-aim Opening Injection Pressure < 15psi

 Nerve stimulation

 Epinephrine in the local anesthetic

DON’T FORGET BP, HR,ECG, SPO2

GENERAL 11

RISK/COMPLICATION
NERVE INJURY
BLOCK FAILURE
INFECTION
BLEEDING
LOCAL ANESTHETIC SYSTEMIC TOXICITY
-seizure
-arrythmia
-respiratory depression
-cardiovascular collapse
 LOCAL
ANESTHETIC
SYSTEMIC
TOXICITY
(LAST)
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TREATMENT 17

OF LAST
H E L A
P T
STO ON ! ! !
C T I
I N JE
MECHANISM OF ACTION THE LIPID 18

EMULSION
The mechanism of LRT is multimodel in action, with lipid
exerting both a scavenging effect (previously known as the
“lipid sink”) and a direct cardiotonic effect.

• The scavenging effect is moderated by the lipid emulsion’s

ability to take up lipophilic moieties and transfer them
around the blood to sites of storage and detoxification.

• The lipid emulsion increases cardiac output through a

combination of volume and direct cardiotonic effects to
improve cardiac output once the cardiac concentration of
drug drops below ion channel–blocking thresholds.
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SUMMARY
THANK YOU