Regional Anaesthesia
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1 Regional Anaesthesia Basic Sciences Anaesthetic Course Dr Vassilis ATHANASSOGLOU FRCA Consultant Anaesthetist and Lecturer in Medicine Oxford University Hospitals NHS Trust, UK Geneva, 5th June 2017
2 Faculty Disclosure No, nothing to disclose Yes, please specify: Acknowledgements Dr Svetlana Galitzine Dr Soumitra Ghosh Dr Paul Townsley Dr Istvan Daroc Dr Michael Mould Dr Chris Spiteri
3 Nuffield Orthopaedic Centre (NOC)
4 Regional anaesthesia always works if you put the right amount of the right stuff in the right place
5 Learning Objectives 40 min to refresh your knowledge in: Physiology and pathophysiology Pharmacology Physics and equipment Applied anatomy and selected blocks
6 Learning Objectives 40 min to refresh your knowledge in: Physiology and pathophysiology Pharmacology Physics and equipment Applied anatomy and selected blocks
7 Regional anaesthesia intends to block generation and conduction of the action potential in the central and peripheral nervous system Key concepts to understand How this works at cellular level - Action potential of the nerve cell Some of the molecular mechanisms behind it Na + and K + voltage gated channels Propagation of action potential
8 ile:action_potential_reloaded.jpg %20Materials/Physiology%20101/Chap ter%20notes/fall%202011/chapter_7% 20Fall% htm e/n/4-the-actionpotential/deck/
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13 Copyright 2017 American Society of Regional Anesthesia and Pain Medicine
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15 Mechanisms of nerve injury Traumatic (mechanical and injection) Vascular (ischaemic) Chemical (Neurotoxic) Inflammatory
16 Etiology of Peripheral nerve injury Anaesthetic factors Type of anaesthetic Intraneural injection Nerve structure Needle type Surgical factors Surgical positioning Tourniquet Postsurgical inflammatory neuropathy Patient factors Preoperative neural compromise Lumbar spinal canal stenosis
17 Have we made peripheral nerve blocks safer by using nerve localisation techniques or monitors?
18 Physiology xxx: Ref:
19 40 min to refresh your knowledge on: Physiology and pathophysiology Pharmacology Physics and equipment Applied anatomy and selected blocks
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27 40 min to refresh your knowledge on: Physiology and pathophysiology Pharmacology Physics and equipment Principles of US Principles of NS Dual guidance: help or hindrance? Applied anatomy and selected blocks
28 Sound is a longitudinal wave that travels in a straight line and requires a medium to go through Frequency exceeding the upper limit of human hearing, which is 20,000 Hz or 20 khz Medical Ultrasound 2MHz to 16MHz Amplitude
29 Image produced by passing an electrical current through a piezoelectrical crystal Low Frequency 3 MHz High Frequency 10 MHz
30 Frequency vs resolution Broadband vs narrowband US waves interaction with tissues Reflection: scattering vs specular Refraction Transmission Attenuation
31 The ultimate goal of any ultrasound system is to make like tissues look the same and unlike tissues look different Resolution Axial Lateral Spatial Temporal
32 Peripheral nerve stimulator
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34 Current: E = K (Q/r 2 ) Polarity: needle cathode Frequency: 1 2 Hz Stimulating needles e.pdf
35 US US vs PNS Direct visualisation nerve and vessels Increase safety PNS Avoids intraneural injection Increase safety Myths Pain on intraneural injection Nerve stimulation at 0.2mA when intraneural
36 40 min to refresh your knowledge on: Pharmacology Physiology and pathophysiology Physics and equipment Applied anatomy and selected blocks
37 Sciatic - yellow Femoral grey Latcutan light grey Obturatorgreen P T P P P T T T
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40 Sonoanatomy for particular PNBs 1. Interscalene 2. Supraclavicular 3. Infraclavicular 4. Axillary 5. Femoral 6. Popliteal
41 Interscalene block Indications: Surgery to shoulder Landmarks: Scalenus anterior & medius, sternocleidomastoid muscle & subclavian artery
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43 Supraclavicular block Indications: Surgery to the arm & hand Landmarks: Subclavian artery, pleura & first rib
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45 Infraclavicular block Indications: Surgery to arm & hand Landmarks: Clavicle, axillary artery & vein, pleura, pectoralis major & minor muscles
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47 Axillary block Indications: Surgery to forearm & hand Landmarks: Anterior axillary fold, posterior axillary fold, axillary artery & vein
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49 Femoral nerve
50 Popliteal block Indications: Foot & ankle surgery (+/- saphenous nerve block) Landmarks: Popliteal vessels (vein superficial to artery), biceps femoris
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52 Thank you for your attention!
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