Podcast
Questions and Answers
What is the mechanism of action for local anesthetics in regional anesthesia?
What is the mechanism of action for local anesthetics in regional anesthesia?
- Increasing the rate of potassium efflux across the nerve membrane, raising the firing threshold
- Prevention of sodium influx across the nerve membrane, decreasing the rate and amplitude of depolarization (correct)
- Inhibiting the release of acetylcholine at the neuromuscular junction, causing muscle paralysis
- Blocking calcium channels in the nerve membrane, preventing action potential propagation
Which of the following is an absolute contraindication for regional anesthesia?
Which of the following is an absolute contraindication for regional anesthesia?
- Severe anatomic distortion
- Coagulopathy
- Neuropathy
- Patient refusal (correct)
Which of the following local anesthetics is known for its differential blockade and lower cardiotoxicity?
Which of the following local anesthetics is known for its differential blockade and lower cardiotoxicity?
- Prilocaine
- Lignocaine
- Bupivacaine (Marcain)
- Ropivacaine (Naropin) (correct)
Which of the following conditions is considered a relative contraindication for regional anesthesia?
Which of the following conditions is considered a relative contraindication for regional anesthesia?
Which of the following pre-operative assessments is NOT specific to regional anesthesia?
Which of the following pre-operative assessments is NOT specific to regional anesthesia?
Which of the following conditions is considered a potential difficulty for regional anesthesia?
Which of the following conditions is considered a potential difficulty for regional anesthesia?
What is the endpoint for identifying the epidural space using the 'loss of resistance' technique?
What is the endpoint for identifying the epidural space using the 'loss of resistance' technique?
Which of the following is a common advantage of performing a regional anesthesia technique using a plexus block?
Which of the following is a common advantage of performing a regional anesthesia technique using a plexus block?
What is the recommended site for performing a spinal or epidural anesthetic block?
What is the recommended site for performing a spinal or epidural anesthetic block?
Which of the following is a potential complication associated with the administration of local anesthetics?
Which of the following is a potential complication associated with the administration of local anesthetics?
What is the primary purpose of using a continuous regional anesthesia technique, such as a continuous brachial plexus or femoral nerve block?
What is the primary purpose of using a continuous regional anesthesia technique, such as a continuous brachial plexus or femoral nerve block?
Which of the following is a potential complication associated with the use of peripheral nerve blocks?
Which of the following is a potential complication associated with the use of peripheral nerve blocks?
What is the primary advantage of using topical anesthesia, such as EMLA cream, for certain procedures?
What is the primary advantage of using topical anesthesia, such as EMLA cream, for certain procedures?
What is the primary purpose of performing a sensory blockade assessment with ice or pin prick during a regional anesthesia procedure?
What is the primary purpose of performing a sensory blockade assessment with ice or pin prick during a regional anesthesia procedure?
Which of the following is a recommended prevention strategy to minimize the risk of local anesthetic toxicity during a regional anesthesia procedure?
Which of the following is a recommended prevention strategy to minimize the risk of local anesthetic toxicity during a regional anesthesia procedure?
What is the primary purpose of post-regional anesthesia management strategies, such as keeping the weak and insensate limb in a sling or padded?
What is the primary purpose of post-regional anesthesia management strategies, such as keeping the weak and insensate limb in a sling or padded?
Study Notes
Mechanism of Action
- Local anesthetics work by blocking the conduction of nerve impulses in regional anesthesia
- They bind to sodium channels in nerve membranes, reducing the influx of sodium ions and preventing depolarization
Contraindications
- Absolute contraindication for regional anesthesia: patient refusal
- Relative contraindication: pre-existing neurological deficits, local infection, bleeding disorders, and anticoagulant therapy
Local Anesthetics
- Differential blockade and lower cardiotoxicity: lidocaine
- Advantage of lidocaine: it can be used for cardiac arrhythmias and has a rapid onset and short duration
Pre-Operative Assessments
- NOT specific to regional anesthesia: laboratory tests (e.g., complete blood count, electrolytes)
- Important assessments for regional anesthesia: coagulation status, platelet count, and neurological examination
Difficulties and Complications
- Potential difficulty: patient anxiety or claustrophobia
- Potential complication associated with local anesthetics: systemic toxicity, allergic reactions, and methemoglobinemia
- Potential complication associated with peripheral nerve blocks: nerve damage, hematoma, and infection
Techniques
- Endpoint for identifying the epidural space using the 'loss of resistance' technique: feeling a sudden decrease in resistance as the needle enters the epidural space
- Recommended site for performing a spinal or epidural anesthetic block: lumbar region (L2-L5)
- Advantage of plexus block: can provide anesthesia for a larger area with a single injection
Continuous Regional Anesthesia
- Primary purpose: to provide prolonged postoperative analgesia and reduce opioid requirements
- Advantage: can reduce the risk of chronic pain and facilitate early mobilization
Topical Anesthesia
- Primary advantage: provides superficial analgesia for minor procedures, reducing the need for injectable anesthetics
- Example: EMLA cream
Sensory Blockade Assessment
- Primary purpose: to evaluate the effectiveness of regional anesthesia and adjust the block as needed
- Methods: ice or pinprick test
Prevention of Local Anesthetic Toxicity
- Recommended strategy: use a test dose, monitor for signs of toxicity, and have resuscitation equipment available
Post-Regional Anesthesia Management
- Primary purpose: to prevent injury and promote patient comfort
- Strategies: keep the weak and insensate limb in a sling or padded, and provide adequate pain management and monitoring
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Description
Test your knowledge on the principles of regional anaesthesia including mechanism of action, advantages, disadvantages, types of regional anaesthesia, potential complications, and post-RA care.
