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Essentials of Regional Anesthesia pp 637–648Cite as

Regional Anesthesia for Chronic Disease States

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Abstract

Regional anesthesia including neuroaxial anesthesia and peripheral nerve blocks as an alternative to general anesthesia, although are very effective and safe, has very few if any absolute indications. On the other hand, these methods of anesthesia or analgesia give the anesthesiologist flexibility to select the best way to conduct anesthesia and offer patient different and more choices to select from, based on their preference. More than often the anesthesiologist chooses to avoid regional anesthesia due to preexisting neurologic, cardiovascular, or other chronic diseases. Obviously, there are certain contraindications to regional anesthesia that needs to be inquired about and investigated in intial evaluation of the patients considered for regional anesthesia. This will leave anesthesiologist with a number of situations that there aren’t enough evidence and clear guidelines to help with decision-making. So the burden of navigating the clinical intricacies and legal consequences of the choices made are based on occasional case reports, retrospective reviews and metanalysis, and finally anesthesiologist experience and decision. For the same reasons, national sociteties practice recommendations and advisories are often ambigious or extremely conservative. Historically, the use of regional anesthetic techniques in patients with preexisting central nervous system (CNS) disorders has been considered relatively contraindicated. If we continue to follow this blanket ban in our daily practice, there would be plenty of patients who will be deprived of multiple benefits from regional anesthesia and analgesia. In most occasions, with better patient selection and individualizing the decision-making process based on risks and benefits of each method selected, we should be able to confidently offer patients regional anesthesia and analgesia. In order to minimize the risks, it may be necessary in certain situations to make some changes in patients with other chronic conditions, such as select one method of regional over others, change dose or concenteration of local anesthetics, or use technologises like ultrasound to improve the safety of procedure.

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Author information

Authors and Affiliations

  1. Anesthesiology and Perioperative Medicine, UCLA Ronald Reagan Medical Center, Los Angeles, CA, USA

    Siamak Rahman M.D. & Parisa Partownavid M.D.

Authors
  1. Siamak Rahman M.D.
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  2. Parisa Partownavid M.D.
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Corresponding author

Correspondence to Siamak Rahman M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Review Questions

Review Questions

  1. 1.

    Which one of these statements are true in patients who are considered for regional anesthesia and had history of preexisting neurologic disease?

    1. (a)

      Regional anesthesia in patients with preexisting seizure disorder is not contraindicated.

    2. (b)

      Nerve fibers that are already compromised are also more vulnerable to injury at another site.

    3. (c)

      Postoperative neurologic complications may be more likely or more severe in patients with preexisting severe spinal stenosis or other obstructive spinal canal pathology.

    4. (d)

      All of the above.

  2. 2.

    Which one is false regarding The American Society of Regional Anesthesia (ASRA) Practice Advisory for Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy?

    1. (a)

      ASRA recommendations are intended for use by anesthesiologists. Other healthcare providers performing neuraxial and peripheral regional anesthetic/analgesic blockade do not need to follow the recommendations.

    2. (b)

      Therapeutic anticoagulation is not contraindicated while the patient has epidural catheter, as long as coagulation status is normalized 2 h prior to catheter removal.

    3. (c)

      Risk of neuraxial hematoma is the same following epidural and spinal anesthesia techniques.

    4. (d)

      All of the above.

  3. 3.

    Which one of the following statements is false?

    1. (a)

      Brachial plexus block probably should not be performed in patients with diaphragmatic dysfunction who are unable to tolerate reduction in pulmonary function.

    2. (b)

      Although epidural anesthesia reduces vital capacity, it is not contraindicated in patients with COPD or asthma.

    3. (c)

      Pulmonary hypertension is an absolute contraindication for epidural anesthesia.

    4. (d)

      Low thoracic epidural anesthesia has minimal effects in lung volume in healthy patients.

Answers

  1. 1.

    d

  2. 2.

    d

  3. 3.

    c

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Cite this chapter

Rahman, S., Partownavid, P. (2018). Regional Anesthesia for Chronic Disease States. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_35

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  • DOI: https://doi.org/10.1007/978-3-319-74838-2_35

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74837-5

  • Online ISBN: 978-3-319-74838-2

  • eBook Packages: MedicineMedicine (R0)

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