Regional anaesthesia – approach

 

1.Preamble

Assessment

·     Hx

·     Ex

·     Ix

Discussion

·     Patient

·     Surgery team

Informed consent

·     Procedure

·     Expectations

·     Benefits

·     Risks

·     Alternatives

 

2.Preparation

Access

·     Peripheral IV

·     Hudson mask

Monitoring

·     SpO2

·     NIBP

·     ECG

Equipment

Block:

·     Ultrasound machine

·     Probe cover

·     Regional kit

·     Sonoplex needles

Resuscitation:

·     Airway

·     Drugs (esp intralipid)

·     Defibrillator

Personnel

·     Anaesthesia assistant for the block

·     ±Technician for positioning

 

3.Performance

Timeout

·     Patient + proceduralist + assistant

·     Ensure correct side

Sedation

·     ±Benzo ± opioid

·     Ensure responsive during needling

Positioning

·     Self

·     Ultrasound machine

·     Patient

Probe

·     Type

·     Depth

·     Gain

Prepare field

·     Chlorhex 0.5% in alcohol 70%

·     Gloves/gown/mask

·     Fenestrated drape

·     Ultrasound probe cover

Block

·     In-plane

·     Needle + tip in view

·     Local infiltration

·     Aspiration before injection

·     Hydrodissection

·     Injection

 

4.Post-procedure

Catheter

·     Written protocol

·     Dedicated pump and tubing

·     Daily review

Monitoring

·     Pain service vs oneself

·     Vital signs

·     Neurovascular

·     Complications

Transition

·     PCA

·     Orals

 

 

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