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Chapter 11. Equipment for Regional Anesthesia

A 30-year-old pregnant woman is scheduled for an elective caesarian delivery. You have decided to perform a spinal anesthetic for her surgery. What type of spinal needle causes less risk of postdural puncture headache?

A. Labat

B. Pitkin

C. Quincke

D. Whitacre

D is correct. Atraumatic needles such as pencil-point tip Whitacre or Sprotte needles are associated with less risk of postdural puncture headache.1,2

A is incorrect. Gaston Labat was one of the pioneers of the widespread acceptance of spinal anesthesia in the 1920s in both Europe and the United States.3

B is incorrect. It was a medium-gauge, short, sharp-beveled cutting spinal needle with a stylet.

C is incorrect. The Quincke spinal needle is a cutting needle.

A 50-year-old man weighing 120 kg was scheduled for a debridement of an infected wrist. A supraclavicular block was performed under ultrasound guidance and nerve stimulator with a threshold of 0.2 mA. Thirty mL of 0.5% ropivacaine was injected after negative aspiration for blood. Ten minutes later, the patient started getting a little restless and began having jerky movement. He also complained of tingling in the mouth. Blood pressure and heart rate remain stable. After managing airway, breathing, and circulation, what do you reach for from the nerve block cart to get ready to administer?

A. Epinephrine

B. Intralipid 20%

C. Midazolam

D. Propofol

B is correct. The symptoms of this patient suggest LA toxicity. Supraclavicular block is a vascular area with potential for LA absorption. Patients who are moribund with infections may have metabolic acidosis, and in turn be predisposed to LA toxicity. The correct management once airway is established is the administration of Intralipid 20% intravenous bolus dose followed by an infusion. Therefore, Intralipid should always be available in the cart where nerve blocks are performed.

A is incorrect. Should there be cardiac or hemodynamic compromise, basic/advanced life support should be initiated and epinephrine will then be appropriate.

C is incorrect. If the symptoms progress to seizure, benzodiazepine should be administered.

D is incorrect. Propofol might be used for seizure suppression but should not be used if there is cardiovascular instability.

A 79-year-old man consented to have a supraclavicular block with sedation for his upcoming hand surgery for flexor tendon repair. He is a vague historian and does ...

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