Chapter 3: Equipment for Peripheral Nerve Blocks

INTRODUCTION

Regional anesthesia equipment has undergone recent technological advances. The practice of regional anesthesia has been substantially modernized with the introduction of ultrasound (US), better needles, catheter systems, and ultrasound monitoring of needle advancement and injection pressure.

INDUCTION AND BLOCK ROOM

Regional anesthesia is ideally performed in a designated area with access to the equipment for the time-efficient and safe practice of peripheral nerve blocks (PNBs). Adequate space, proper lighting, equipment, drugs, and material to perform blocks are essential. Full patient monitoring, source of oxygen, equipment for emergency airway management and positive-pressure ventilation, and access to emergency drugs are all necessary (Figure 3-1). When performing the block, an assistant trained in regional anesthesia is useful to prepare and handle equipment and help with the procedure.

Cardiovascular and Respiratory Monitoring During Application of Regional Anesthesia

Patients receiving regional anesthesia should be monitored with the same degree of vigilance as patients receiving general anesthesia. Local anesthetic (LA) toxicity due to intravascular injection or rapid absorption into the systemic circulation is uncommon but potentially a life-threatening complication. Likewise, premedication, often beneficial for patient comfort and acceptance of regional anesthesia procedures, may result in respiratory depression, hypoventilation, and hypoxia. Patients often present with comorbidities and clinical conditions that require monitoring during and after the block procedure and would go unnoticed without proper monitoring (e.g., arrhythmias, hypertension, hypoxemia). For these reasons, patients receiving PNBs should always have vascular access and be appropriately monitored. Routine cardiorespiratory monitoring should consist of pulse oximetry, noninvasive blood pressure, and electrocardiography. Respiratory rate and mental status should also be monitored. LA toxicity has a biphasic pattern and should be anticipated during the injection, immediately after the injection, and again 10 to 30 minutes after the injection. Signs and symptoms of toxicity occurring during or shortly after the completion of the injection are due to an intravascular injection or channeling of LAs to the systemic circulation (1-2 minutes). In the absence of intravascular injection, the typical absorption rate of LAs after injection peaks at approximately 10 to 30 minutes after the performance of a PNB; therefore, patients should be continuously and closely monitored for at least 60 minutes for signs of LA toxicity.

Regional Anesthesia Equipment Storage Cart

A regional anesthesia cart should be portable to enable transport to the point of care. The anesthesia cart should also be well stocked with all the necessary equipment and supplies, which should be well labeled and readily identifiable so that practitioners ...