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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.

Clinical Pearl
  • 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.

Fig. 17-1

An example of room/area with basic monitoring equipment.

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.

Clinical Pearls
  • 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 during or immediately following the injection ...

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