Anesthesia and Nerve Block Complications
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Questions and Answers

What is a limitation of Ultrasound-Guided Regional Anesthesia (UGRA) techniques?

  • Reduces the number of needle insertions
  • Adds an additional layer of complexity (correct)
  • Improved block quality
  • Shortens the learning curve for regional anesthesia

    • What is an advantage of UGRA over traditional techniques?

  • Relies heavily on anatomic landmarks
  • Requires a longer learning curve for regional anesthesia
  • Provides real-time imaging of needle advancement (correct)
  • Increases the number of needle insertions

    • What is a benefit of using Ultrasound-Guided Regional Anesthesia (UGRA) techniques?

  • Decreases the incidence of block failure (correct)
  • Limits alternative approaches for nerve blockade
  • Increases the false negative rate of nerve stimulation techniques
  • Slows down the learning curve for regional anesthesia

    • What is not a complication prevented by Peripheral Nerve Stimulation (PNS)?

    <p>Motor response</p> Signup and view all the answers

    What is the primary benefit of regional anesthesia in terms of patient recovery?

    <p>Improved physical therapy, mobility, and functional recovery after surgery</p> Signup and view all the answers

    What is a traditional technique that UGRA improves upon?

    <p>Nerve stimulation techniques</p> Signup and view all the answers

    What is a potential complication of regional anesthesia due to bleeding into a fixed and noncompressible space?

    <p>Spinal hematoma</p> Signup and view all the answers

    What is a reason to use Ultrasound-Guided Regional Anesthesia (UGRA) techniques?

    <p>To improve upon the false negative rate of nerve stimulation techniques</p> Signup and view all the answers

    What is an advantage of using Ultrasound-Guided Regional Anesthesia (UGRA) techniques?

    <p>Reduces the number of needle insertions</p> Signup and view all the answers

    What is a consideration for regional anesthesia in a patient with a preexisting neurologic injury?

    <p>Existing neurologic injury</p> Signup and view all the answers

    What is the primary reason for managing regional anesthesia differently in patients undergoing plexus or peripheral techniques?

    <p>All of the above</p> Signup and view all the answers

    What does UGRA allow for?

    <p>Visualization of nerve location and surrounding anatomic structures</p> Signup and view all the answers

    What is a potential harm associated with regional anesthesia?

    <p>Local anesthetic toxicity</p> Signup and view all the answers

    What is a consideration for regional anesthesia in a patient with anticoagulation issues?

    <p>Anticoagulation issues</p> Signup and view all the answers

    What is classified by degree of functional disruption in regional anesthesia?

    <p>Neurologic injury</p> Signup and view all the answers

    What is a benefit of regional anesthesia in terms of pain management?

    <p>Less need for narcotics and/or pain medications</p> Signup and view all the answers

    What is the typical length of the needle used for a Lumbar plexus block?

    <p>100 mm (4 in)</p> Signup and view all the answers

    Which of the following blocks typically requires the longest needle?

    <p>Sciatic block: anterior approach</p> Signup and view all the answers

    What is a benefit of using a continuous infusion catheter?

    <p>Improved ability to participate in rehabilitation</p> Signup and view all the answers

    What is the typical length of the needle used for a Thoracic paravertebral block?

    <p>90 mm (3.5-4 in)</p> Signup and view all the answers

    Which of the following blocks typically requires a needle length of 25 mm (1 in) to 50 mm (2 in)?

    <p>Interscalene brachial plexus block</p> Signup and view all the answers

    What is a benefit of single-injection blocks?

    <p>Faster onset of analgesia</p> Signup and view all the answers

    What is the typical length of the needle used for a Popliteal block: lateral approach?

    <p>100 mm (4 in)</p> Signup and view all the answers

    What is the typical length of the needle used for a Sciatic block: posterior approach?

    <p>100 mm (4 in)</p> Signup and view all the answers

    What is the primary mode used in regional anesthesia?

    <p>B-Mode</p> Signup and view all the answers

    What is the purpose of adjusting the gain in optimizing image quality?

    <p>To amplify the returning signal</p> Signup and view all the answers

    What is the result of relative motion between the sound source and the sound receiver?

    <p>A change in the frequency or wavelength of the sound wave</p> Signup and view all the answers

    What type of image is generated in A-Mode?

    <p>A simple one-dimensional ultrasound image</p> Signup and view all the answers

    What is the primary use of M-Mode?

    <p>Cardiac and fetal cardiac imaging</p> Signup and view all the answers

    What is the purpose of using Doppler-Mode?

    <p>To produce a color-coded map of Doppler shifts</p> Signup and view all the answers

    What is the significance of 'X' in needle guidance?

    <p>It marks the spot where the needle should be inserted</p> Signup and view all the answers

    What is the effect of compensating for attenuation in optimizing image quality?

    <p>It amplifies the returning signal</p> Signup and view all the answers

    What is a potential cause of nerve injury following a peripheral nerve block?

    <p>A bandage that is too tight</p> Signup and view all the answers

    What is crucial to do for patients who receive regional anesthesia?

    <p>Follow them until sensory and motor function return</p> Signup and view all the answers

    What is essential for success in regional anesthesia?

    <p>All of the above</p> Signup and view all the answers

    What does the acronym SCANNING stand for?

    <p>Supplies, Comfort, Ambiance, Name, Nominate, Infection control, Note, Gain</p> Signup and view all the answers

    What is a key aspect of patient education in regional anesthesia?

    <p>Explaining the procedure and its benefits</p> Signup and view all the answers

    What is essential for the anesthesia team in regional anesthesia?

    <p>Proper communication among team members</p> Signup and view all the answers

    What is critical in the postoperative management of regional anesthesia?

    <p>Following up with the patient until full recovery</p> Signup and view all the answers

    What is a consideration in regional anesthesia when managing a patient with a preexisting neurologic injury?

    <p>The potential for further neurologic damage</p> Signup and view all the answers

    Study Notes

    Regional Anesthesia Benefits

    • Improved analgesia
    • Less need for narcotics and/or pain medications
    • Improved physical therapy, mobility, and functional recovery after surgery
    • Decreased recovery room and/or hospital stay
    • Improved blood flow to extremity due to sympathectomy
    • Improved patient satisfaction

    Regional Anesthesia Disadvantages

    • Potential for harm: local anesthetic toxicity, cardiac collapse, seizure, allergic reaction, respiratory compromise, paresthesia, nerve injury, infection, hematoma, and failed block

    Regional Anesthesia Considerations

    • Patient refusal
    • Surgeon refusal
    • Clinician lack of knowledge or skill
    • Infection at sight of block
    • Existing neurologic injury
    • Patient cooperation (pediatrics, combative, dementia)
    • Anticoagulation issues
    • Bloodstream infection
    • Allergy to local anesthetics
    • Preexisting peripheral neuropathy

    Regional Anesthesia for a Coagulated Patient

    • Spinal hematoma is the most significant hemorrhagic complication of regional anesthesia
    • Due to bleeding into a fixed and noncompressible space
    • Management (performance, catheter maintenance, and catheter removal) based on site compressibility, vascularity, and consequences of bleeding, should it occur

    Neurologic Injury

    • Classified by degree of functional disruption
      1. motor response disappears after injection of local anesthetic or saline
    • PNS does not prevent intravascular, intraneural, or pleural puncture

    Ultrasound-Guided Regional Anesthesia

    • Decrease the incidence of block failure
    • Improve upon the false negative rate of nerve stimulation techniques
    • Allows for alternative approaches for nerve blockade
    • May accelerate the learning curve for regional anesthesia
    • Additional layer of safety

    Advantages of UGRA

    • Allows for visualization of nerve location and surrounding anatomic structures
    • Provides real-time imaging of needle advancement and local anesthetic injection
    • Reduces the number of needle insertions
    • Studies have shown that the addition of ultrasound improves the block quality, onset time, and success rate

    Limitations of UGRA

    • Adds an additional layer of complexity
    • Needles may be slightly longer for ultrasound-guided blocks

    Single-Injection vs. Continuous Infusion

    • Catheter benefits: prolonged analgesia, improved ability to participate in rehabilitation, and improved patient satisfaction

    Continuous Infusion Needle Systems

    • Prolonged analgesia
    • Improved ability to participate in rehabilitation
    • Improved patient satisfaction

    Block Room

    • Needed equipment: Doppler

    U/S Image Modes

    • A-Mode: a simple one-dimensional ultrasound image generated as a series of vertical peaks corresponding to the depth of the structures
    • B-Mode: a two-dimensional image of the area, with horizontal and vertical directions representing real distances in tissue, and intensity of the grayscale indicating echo strength
    • Doppler-Mode: a color-coded map of Doppler shifts superimposed onto a B-mode ultrasound image
    • M-Mode: a single beam used to produce a picture with a motion signal, where movement of a structure can be depicted in a wave-like manner

    Optimizing Image Quality

    • Appropriate probe
    • Adjust depth
    • Compensate for attenuation with gain
    • Optional modes: A, B, and M

    Needle Guidance Fundamentals

    • "X" marks the spot: needle guidance fundamentals

    Long vs. Meds Before the Block Wears Off

    • Remember that a nerve injury following a peripheral nerve block may not be from the peripheral nerve block
    • Always follow patients who receive regional anesthesia until sensory and motor function return

    Assess Your Work

    • Follow patients who receive regional anesthesia until sensory and motor function return

    Time to Make the Donuts

    • Keys to success: the anesthesia team, technique, preoperative management, patient selection, patient education, surgeon, intraoperative management, postoperative management

    Keys to Success

    • Acronym for success: SCANNING
    • S: Supplies
    • C: Comfortable positioning
    • A: Ambiance
    • N: Name and procedure
    • N: Nominate a transducer
    • I: Infection control
    • N: Note lateral/medial side on screen
    • G: Gain and depth adjustments

    Local Anesthetics

    • Sensory vs. motor block

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    Related Documents

    2024 Furstein Foundations of UGRA.pptx

    Description

    This quiz covers the importance of closely monitoring patients after peripheral nerve blocks and regional anesthesia, and the potential complications that can arise. It also highlights the need to rule out other causes of nerve injury.

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