Chapter 3. Equipment for Peripheral Nerve Blocks

Over the past several decades, regional anesthesia equipment has undergone substantial technological advances. Historically, the development and consequent introduction of the portable nerve stimulator to clinical practice in the 1970s and 1980s was a critical advance in regional anesthesia, allowing the practitioner to better localize the targeted nerve. In recent years, however, the advent of ultrasound, better needles, catheter systems, and monitoring has entirely rejuvenated, if not revolutionized, the practice of regional anesthesia.

Regional anesthesia is ideally performed in a designated area with access to all the appropriate equipment necessary to perform blocks. Whether this area is the operating room or a separate block room, there must be adequate space, proper lighting, and equipment to ensure successful, efficient, and safe performance of peripheral nerve blocks (PNBs). Provision for proper monitoring, oxygen, equipment for emergency airway management and positive-pressure ventilation, and access to emergency drugs is of paramount importance (Figure 3-1).

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 toxicity due to intravascular injection or rapid absorption into systemic circulation is a relatively uncommon but potentially life-threatening complication of regional anesthesia. Likewise, premedication, often necessary before many regional anesthesia procedures, may result in respiratory depression, hypoventilation, and hypoxia. For these reasons, patients receiving PNBs should have vascular access and be appropriately monitored. Routine cardio-respiratory monitoring should consist of pulse oximetry, noninvasive blood pressure, and electrocardiogram. Respiratory rate and mental status should also be monitored. The risk of the local anesthetic toxicity has a biphasic pattern and should be anticipated (1) during and immediately after the injection and (2) 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 local anesthetics to the systemic circulation (1–2 minutes). In the absence of an intravascular injection, the typical absorption rate of local anesthetics after injection peaks at approximately 10 to 30 minutes after performance of a PNB1; therefore patients should be continuously and closely monitored for at least 30 minutes for signs of local anesthetic toxicity.

Tips

• Routine monitoring during administration of nerve blocks:
  • Pulse oximetry
  • Noninvasive blood pressure
  • Electrocardiogram
  • Respiratory rate
  • Mental status

Regional Anesthesia Equipment Storage Cart

A regional anesthesia cart should have all drawers clearly labeled and be portable to enable transport to the patient's bedside. The anesthesia cart should also be well stocked with all equipment necessary to perform PNBs effectively, safely, and efficiently. Supplies such as needles and catheters ...