Regional anesthesia has become commonplace in many practices worldwide due to the increasing evidence of patient benefit, such as reduction in pulmonary1 and thromboembolic2 complications, reduction in opioid consumption,3 as well as reduced pain and time to discharge and better quality of life in the immediate postoperative period.4 The increased popularity of regional anesthesia has resulted in advancement in techniques and equipment. The practice has evolved from using paresthesia for nerve localization to electrical nerve stimulation and, currently, to ultrasound. This chapter gives an overview of the equipment available in the practice of peripheral nerve blocks. It also outlines the equipment needed at various stages of the regional anesthesia procedure to ensure that it proceeds in an efficient and safe manner. The practice of regional anesthesia comprises equipment, protocols, and skills necessary to ensure that the block proceeds as smoothly and safely as possible—before, during, and after the block is administered.
REGIONAL BLOCKADE PREPARATION AND SETUP
A quiet environment with all equipment necessary to perform regional anesthesia, together with resuscitation drugs and equipment within reach, is of paramount importance. An ideal location is an induction room where the patient can be monitored, premedicated and the regional block performed before transferring to the operating theater. A designated block area can be used to provide suitable, monitored procedure environment while optimizing operating room efficiency.
When performing the block, an assistant trained in regional anesthesia should be present to prepare and handle equipment and help with the injectate. The assistant should also be trained in performing resuscitation if it becomes necessary.
Regardless of where the block is performed, it is essential to have all equipment, drugs, and monitoring readily available. The best way to gather all the necessary equipment and drugs is the setup of a storage cart (Figure 12–1), which should be well labeled with the supplies readily identifiable.
Equipment storage cart with clear identification of supplies and medication.
Block Area General Equipment
Commonly used items should be stocked in the storage cart and refilled when necessary. The storage cart should contain the following:
Sterile skin preparation solution, sponges/gauze, drape, marking pen, ruler for landmark identification, ultrasound gel, hypodermic needles for skin infiltration and drawing up 5% dextrose (5% dextrose in water, D5W).
A selection of sedatives, for example, midazolam (0.5–3 mg IV), and short-acting opioids such as fentanyl (50–100 μg IV), and propofol (20–100 mg IV) for nerve blocks that are more uncomfortable and require deeper sedation (eg, ankle block)....