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Regional Nerve Block in Anesthesia and Pain Therapy: General Consideration

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Regional Nerve Blocks in Anesthesia and Pain Therapy

Abstract

Regional anesthesia means the interruption of impulse conduction in the nerves using specific, reversibly acting drugs (local anesthetics). The indications for regional anesthesia include clinical anesthesia, obstetrics, postoperative analgesia, and pain therapy. Before conducting regional anesthesia, the same type of assessment of the patient should be carried out as for general anesthesia. To ensure cooperation, the patient should be given simple, short information about the aim of the block, its technical performance, possible or probable paresthesia and their significance, as well as the potential complications. The patient information session and consent, either verbal or written, should be documented. It is important that a number of safety measures are taken to ensure the most suitable regional anesthesia technique is performed for the correct patient. The comprehensive record and checklist has pertinent information including purpose of the block, position and approach, type of local anesthetics used, and complications that might arise. Such standardized recommendations are useful for the purpose of medicolegal documentation and conducting retrospective studies on complications. In addition, the detailed pharmacology of local anesthetic and the use of regional anesthesia in patient on anticoagulants or antiplatelet agents will also be reviewed.

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Notes

  1. 1.

    The antiplatelet effect is not immediate. Neuraxial catheters may be maintained for 1–2 days provided a loading dose of the antiplatelet agent is not administered.

  2. 2.

    In patients with high risk of thromboembolic events or for trial of SCS: a 5 day discontinuation is recommended (e.g., a “bridge” therapy with low molecular weight heparin). After an intervention, the usual daily dose (75 mg) of clopidogrel can be started 12 h later.

  3. 3.

    Risk-benefit assessment: higher bleeding risk profiles, concomitant antiplatelet medications, advanced patient age, advanced liver or renal disease, or prior history of abnormal bleeding exist.

  4. 4.

    Neuraxial catheters should not be maintained with prasugrel or ticagrelor because of the rapid onset. Thienopyridine therapy may be resumed immediately after needle placement/ catheter removal, provided a loading dose of the drugs is not administered. If loading dose is administered, ASRA suggests a time interval of 6 h between catheter removal and administration.

  5. 5.

    Risk-benefit assessment: higher bleeding risk profiles, concomitant antiplatelet medications, advanced patient age, advanced liver or renal disease, or prior history of abnormal bleeding exist.

  6. 6.

    Although the LMWHs constitute a relatively homogenous pharmacological group, the most studied and referenced drug is Enoxaparin; there are different commercial preparations on the market that share common characteristics but that also possess different clinical and pharmacological properties and must be regarded as similar but not equal drugs.

  7. 7.

    The safety of indwelling neuraxial catheters in patients receiving doses >5000 U or > 15,000 U of UFH/day has not been established. The risk and benefits be assessed on an individual basis (neurologic monitoring).

  8. 8.

    Enoxaparin 30 mg BID or 40 mg /once d.

  9. 9.

    Enoxaparin 1 mg/kg every 12 h; Dalteparin 120 U/kg every 12 h, 200 U/kg every 12 h; Tanzaparin 175 U/ kg day.

  10. 10.

    Prophylactic dose for joint replacement.

  11. 11.

    Risk reduction or treatment for VTE or PE; RA-regional anesthesia procedure including manipulation or removal of catheter.

  12. 12.

    72 h (3 days) (CrCl ≥80 mL/min); 96 h (4 days) (CrCl 50–79 mL/min); 120 h (5 days) (CrCl 30–49 mL/min) (ASRA).

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  1. Pain Management Centre DGS – Cologne – Huerth, Cologne-Hürth, Germany

    Danilo Jankovic

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    Danilo Jankovic

  2. Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, ON, Canada

    Philip Peng

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Jankovic, D. (2022). Regional Nerve Block in Anesthesia and Pain Therapy: General Consideration. In: Jankovic, D., Peng, P. (eds) Regional Nerve Blocks in Anesthesia and Pain Therapy. Springer, Cham. https://doi.org/10.1007/978-3-030-88727-8_1

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