Chapter 11: Preparation for Regional Anesthesia and Perioperative Management

INTRODUCTION

The practice of regional anesthesia involves a preoperative assessment, patient information, adequate preparation, objective monitoring of block administration, and monitoring of respiratory and cardiovascular parameters. These activities should be standardized and recorded as standardized documentation where applicable.

This chapter describes the suggested steps for the perioperative management of patients receiving regional anesthesia. While the suggestions here apply to all regional anesthetics, more detail, uniquely applicable to the specific procedures, will be detailed in their respective chapters.

PREANESTHETIC EVALUATION AND INFORMATION

• Assess comorbidities relevant for anesthesia and the specific blocks (e.g., pre-existing neurologic symptoms, respiratory insufficiency for proximal brachial plexus blocks, coagulation disorders/anticoagulants).

• Discuss indications and specifics of the regional anesthesia technique with the patient and obtain informed consent, if applicable.

• Evaluate the anatomical area of regional anesthesia for potential contraindications or limitations that would require alternative approaches (e.g., scars, infections, osteosynthesis material, inability to adequately position or expose the area of interest).

• Apply similar fasting guidelines as for general anesthesia. In the absence of contraindications, allow the intake of clear fluids up to 2 hours prior to the surgical procedure.

• As opposed to general anesthesia, removal of the dentures etc., is typically not necessary for patients receiving regional anesthesia.

PATIENT PREPARATION

• Ensure patient privacy and comfort.

• Perform a checklist (a) on patient arrival and (b) just before the intervention.

• Confirm the surgical procedure, regional anesthesia procedure, and side to be anesthetized.

• Explain to the patient the planned procedure and what to expect post-procedure (i.e., the duration and distribution of the sensory-motor block).

• Apply the standard American Society of Anesthesiologists (ASA) monitoring.

• Initiate intravenous (IV) access.

• Position the patient for the planned procedure (refer to the techniques chapters).

• Administer supplementary oxygen.

• Administer IV analgesia and anxiolysis as necessary, best as a routine protocol.

EQUIPMENT AND PERSONNEL

• Establish and train a dedicated block room nursing personnel team.

• Establish standardized protocols for equipment for each commonly used regional anesthesia procedure.

• Block nurses are essential for regional anesthesia service. Their service functions best also when patient care, regional anesthesia techniques, equipment, indications, and perioperative care are standardized within the entire service.

• In addition to the patient preparation, establish and train the nursing team to prepare the equipment for regional anesthesia and assist in the block performance:

  • Prepare ultrasound (US) machine and position it correctly, standardized ergonomics.

  • Help with the general setup of the US machine (transducer, mode, frequency, time gain compensation, initial depth).

  • Prepare the nerve stimulator with the correct settings.

  • Prepare the regional anesthesia tray with the protocoled medication, needle, injection pressure monitoring (where used), etc. (See Figure 11-1.)

  • Prepare sterile gloves, sterile US transducer cover and, for catheter placement, a sterile gown.