As in other areas of medicine, anesthesiologists increasingly rely on
more sophisticated equipment in regional anesthesia. The advanced technology
used to accomplish and increase the success rate of regional anesthesia
techniques requires thorough understanding of the equipment. One of the most
important advances in regional anesthesia was the introduction of the
portable peripheral nerve stimulator in the late 1970s and early
1980s.1 Since that time, many improvements in nerve
stimulators were made, as well as to the needle and catheter designs. Over
the last decade, ultrasound also developed into a promising method for nerve
localization.1–3 As technology continues to evolve, it
will likely assume a more significant role in regional anesthesia.
Nevertheless, the performance of regional anesthesia techniques still
requires proper set-up, careful preparation, detailed planning, and
continuous monitoring to provide safe and effective patient care.
A designated area with proper equipment and monitoring devices is
essential for providing effective and safe regional anesthesia.
Regional anesthesia should be performed only in a designated area with
the proper equipment (Figure 17–1). This area could be the
operating room or a separate area within the surgical suite. Regardless of
where the actual procedure is performed, adequate space, proper equipment,
and careful monitoring are essential to ensure time-efficient and safe care
of the patient undergoing the peripheral nerve block.4–6
To facilitate the successful implementation of a nerve block, all supplies,
drugs, and other equipment must be readily available in the room. The
designated area must be large enough to enable proper monitoring and
resuscitation of patients. And it should have proper lighting, suction, and
equipment for oxygen administration and emergency airway management,
including positive-pressure ventilation.
An example of room/area with basic monitoring
Toxicity from an inadvertent intravascular injection or rapid
absorption or channeling of local anesthetic into the systemic circulation
is always a potential risk when administering local anesthetic for any
regional block. Vigilant monitoring is crucial for diagnosing and managing
any potential complications that arise during or after a regional anesthesia
or analgesia procedure.4,7 Every patient should have
vascular access secured prior to performing the procedure.
Patients having regional anesthesia should be monitored similarly to
patients undergoing general anesthesia.
Level of consciousness, pulse oximetry, vital signs (blood pressure and
heart rate), electrocardiogram (ECG), and respiratory rate should be
monitored and documented throughout the procedure.
The patient's baseline level of consciousness, pulse oximetry, vital
signs (blood pressure and heart rate), ECG, and respiratory rate should be
monitored throughout the procedure. After completion of the block, all
patients should be monitored for at least 30 min for any signs of local
anesthetic toxicity. It is important to keep in mind that although a toxic
reaction typically occurs ...