Regional anaesthesia – complications:

 

List of complications:

Localised

·     Infection

·     Bleeding

·     Failure

·     Neurapraxia

Systemic

·     LAST (overdose or intravascular)

·     Agent-specific toxicity

Specific

·     Pneumothorax

·     Phrenic nerve palsy

 

Prevention:

Patient selection

·     Withhold or reverse anticoagulants

·     Beware neuro pathology

Communication

·     Block time out – nurse + patient

·     Awake patient

·     Tell me if you feel ‘x’

Equipment

·     Ultrasound

·     Nerve stimulator

·     Blunt needle with short bevel

·     Chlorhex 0.5% (not higher) in alcohol 70%

Positioning

·     Sitting

·     Comfortable table height

·     Shoulders relaxed, elbows at 90 degrees

·     Needle, patient, screen all in line

·     Rest ultrasound hand on patient

Ultrasound

·     Pre-scan 2D and doppler -identify structures

·     In-plane

Needling

·     Shallow needle angle for reflection

·     Whole needle and tip in view

Injecting

·     Slow injection

·     Don’t inject against resistance

·     Confirm correct location of spread

·     Minimise dose

·     Minimise volume

Surgery

·     Positioning

·     Tourniquet time