REGIONAL ANESTHESIA

Regional anesthesia is a type of pain management for surgery that numbs a large part of the body, such
as from the waist down. The medication is delivered through an injection or small tube called a catheter
and is used when a simple injection of local anesthetic is not enough, and when it’s better for the
patient to be awake.

Regional anesthesia is the use of local anesthetics to block sensations of pain from a large area of the
body, such as an arm or leg or the abdomen. Regional anesthesia allows a procedure to be done on a
region of the body without your being unconscious.

What is Epidural Anesthesia?

Regional anesthesia that prevents pain in certain parts of the body.

The goal of having an epidural is to have some pain relief instead of loosing feeling in your whole
body.

You loose feeling in the lower half of your body starting at your lower spine down to your feet.

is a technique that may be used as a primary surgical anesthetic or as a resource for postoperative
pain management.

Epidural anesthesia is a technique for perioperative pain management with multiple applications in
anesthesiology. It is useful as a primary anesthetic, but most commonly, it is used as a pain management
adjuvant. It can be a single shot or a continuous infusion for long-term pain relief. Aside from the benefit
of potentially providing excellent analgesia, its use reduces the exposure to other anesthetics and
analgesics, decreasing side effects. It has also shown to decrease cortisol levels, expedite the return of
bowel function, decrease the incidence of PULMONARY EMBOLISM and DEEP VEIN THROMBOSIS in the
postoperative period, and shorten lengths of in-hospital stay

Types of Epidural Anesthesia?

1. Regular Epidural (used by most women) Pumped or injected into your lower spine through a
catheterCombination of narcotics and anesthetics (given with the epidural to decrease the required
dose of local anesthetic)

2. Combined Spinal-Epidural (CSE) “walking epidural” Inserted into the intrathecal area through a
catheter Can be either a narcotic or anesthetic or both at once. Allows you to move more freely (walk
around) Allows pain relief for 4-8 hours

Example of Local Anesthesia

AMIDEs
- Bupivacaine

-Lidocaine

-Ropivacaine

-Mepivacaine

-Prilocaine

ESTERS

- Chloroprocaine

- Cocaine

-Novocaine

- Tetracaine

EPIDURAL LOCALBupivacaine (marcaine)

- local anaesthetic works as ananalgesic (subanesthetic dose)- inhibiting impulse transmission

inthe nerve fibers- sensory nerves are blocked firstbefore the motor fibers- sensory fibers
carrying the pain isblocked before those carrying heatcold touch and pressure.

Indications

Epidurals are useful for surgical anesthesia of thoracic surgery, major intra-abdominal surgery, or spine
surgery, granted that muscle relaxation is not needed. This technique may also be for intra-op or post-
op pain management. It may decrease the surgical risk and morbidity of certain patient populations, for
example, patients with ischemic cardiac disease. It also has been shown to decrease post-op lung
complications and increase the intestinal return of function after abdominal surgery.

1. Young age of woman in labor (up to 18 years)

2. Abnormalities of Labor

3. a sharp increase in blood pressure

4. Premature birth

5. Severe pain syndrome

6. risk od cesarean section

Contraindications

Absolute

 Refusal of the patient

 Bacteremia

 Local infection at the site of puncture

 Hemorrhagic diathesis or therapeutic anticoagulation

 Increased intracranial pressure

Relative [4]

 Significant aortic stenosis

 Right to left shunt and pulmonary HTN

 Anatomical deformities of the spine

Nursing Responsibilities

The sensory block should be assessed 4 hourly and on the following times

 In PACU after rousing from the anaesthetic, and immediately after patient initial bolus dose
 On return to the ward
 If the patient complains of pain
 One hour after a bolus or rate change
The motor block should be assessed 4 hourly and at the following times

 In PACU after waking from the anaesthetic

 On return to the ward
 Prior to ambulation if required
 One hour after a bolus or rate change
The catheter insertion site should be checked 8 hourly for any redness, tenderness or leaking. If visible
the catheter markings should be checked to make sure there has been no movement of the epidural
catheter. The dressing should also be checked and reinforced if any tape is lifting
The epidural would be expected to last for 3- 4 days unless there are adverse events

STAFF NURSE RESPONSIBILITIES

1. Upon receiving patient check for:1.1. IV cannula1.2. urinary catheter1.3. epidural catheter length (if
visible)1.4. if dressing is intact1.5. doctors order1.6. ongoing epidural infusion bag
90 STAFF NURSE RESPONSIBILITIES
2. Assess and monitor as indicated on epidural flowsheet.3. Notify APS or on call anesthetist any
untoward complications, emergency, side effects or inadequate relief related to therapy.3.1 pager aps
anaesthetist weekdays 0730 – 16003.2 pager aps nurse weekdays 0730 – 16003.3 pager maternity on
call anaesthetist – 0730 daily and weekends

91 STAFF NURSE RESPONSIBILITIES

4. Certified nurse should connect the new bag.5. CN are allowed to increase or decrease the infusion
rate based on the rate ordered or patients pain response from ongoing infusion.6. Infusions:6.1. if used:
discard with the presence of other witness or staff.6.2. if not used: Incident report and send back to
pharmacy.7. Keep patent IV access and continue to monitor for 12 hours after removing the epidural
catheter.8. Inform APS team or on call anesthetist if patients is on anticoagulant.