Presentation as part of debate with Professeur Hervé Bouaziz at Euroanaesthesia 2015

1. 1
Pro: I do perform nerve
blocks in anaesthetized
patients
Colin J.L. McCartney
MBChB PhD FRCA FCARCSI FRCPC
Head of Anaesthesia
The Ottawa Hospital,
Professor and Chair of Anaesthesia
University of Ottawa, ON, Canada

2. Conflicts of Interest
• None

3. Definition of Anaesthesia
an·es·the·sia
an s THēZH /ˌ ə ˈ ə
noun
noun: anaesthesia; noun: anesthesia
insensitivity to pain, especially as artificially
induced by the administration of gases or the
injection of drugs before surgical operations.

4. Regional Anaesthesia
• no-brain·er (nō brā n r)′ ′ ə
• n. Informal
• Something, especially a choice or decision,
that is so obvious or easy as to require little or
no thought.

5. Benefits of RA
• Reduced pain
• Reduced nausea
• Faster discharge
• Faster return of GI function
• Improved rehabilitation
• Reduced respiratory complications
• Reduced MI and CVS complications
• etc etc

6. Cepeda et al A&A 2005

7. Insert recent RA meta-analysis
Richman JL et al A&A 2006
Continuous RA vs Opioid:

8. Regional Anesthesia and Impact on
Perioperative Medicine

9. Memtsoudis SG RAPM 2013

10. Patient Opinion of Regional
Anesthesia?

11. Patient fears about regional
anesthesia?
• Pain during the block
• Pain in the operating room
• Being awake for surgery
• Failure of the block

12. Patients opinions regarding RA

13. Overcoming fears
• Reassurance about sedation/anaesthesia
during block performance
• Proper informed consent
• Use of all modalities to avoid risk of nerve
injury (stimulation, injection pressure,
ultrasound guidance etc)

14. Special populations
• Children
• Trauma

15. Paediatric regional anaesthesia
15

16. What do we fear about doing
blocks on asleep patients?

18. Recognize causes of nerve injury
and balance risks
• Patient, Surgical and Anaesthesia related
factors
• Appropriate and documented informed
consent
• Recognize contribution of tourniquet and
other surgical causes
• More proximal blocks ? Higher risk

19. Don’t do stupid stuff:

21. Get Practice

22. Kathy Sierra: http://headrush.typepad.com/creating_passionate_users/2006/03/how_to_be_an_ex.html

23. J Shoulder Elbow Surgery 2007; 16 (Jul/Aug): 379-387

24. Follow up with your patient

25. Yes-I do blocks in asleep patients
• Not all blocks
• Most blocks deeply sedated
• Some blocks on anaesthetized patients:
specific populations
• Good informed consent, careful technique
and follow up essential for all regional
anaesthesia