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#36910 How do we define success in regional anesthesia (RA)?
  1. André Van Zundert
  1. Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital and The University of Queensland, Herston-Brisbane, Australia


A successful RA block is the accomplishment of providing a satisfactory central neuraxial, peripheral nerve or plane block using local anesthetic solutions to enable the surgeon/obstetrician to perform certain operations on patients in a safe (devoid of complications), efficient (how easily or quickly placement is performed) and effective (pain free) way with a positive outcome.

These blocks are typically performed by well-trained anesthesiologists who have expertise in the field. They need to know all necessary safeguards to avoid potential negative consequences of a loco-regional block, i.e., toxicity and high/total spinal anesthesia, as a complication of an epidural puncture.

The use of ultrasound guidance for inserting peripheral nerve blocks has become the standard practice, as it allows for more accurate needle placement. Blind-insertion techniques should become more the exception. Proper training, adherence to hygienic standards, and the availability of necessary equipment and drugs are crucial for performing RA blocks safely in a monitored environment supported by nursing staff.

Complications associated with RA blocks can arise, including toxicity or high/total spinal anesthesia as a result of epidural puncture. Anesthesiologists need to be prepared and take necessary precautions and have resuscitation equipment and drugs need readily available. In case of local anesthetic overdose or toxicity, the immediate availability of 20% intralipid can be crucial for treatment. RA has its specific complications often related to its reliance based on subjective feelings (loss-of-resistance to air as in epidurals), e.g., postdural puncture headache, where others may have neurological complications (peripheral blocks puncturing nerves). Even supervisors can not see what is happening at the other end of the needle and never can be sure whether the true loss-of-resistance is being felt. Training RA techniques in simulation circumstances is essential.

Like other areas of healthcare, anesthesiologists should also strive for environmentally sustainable practices. The healthcare industry as a whole contributes between 4 and 5% of the global greenhouse gas emissions. While RA techniques themselves are environmentally friendly, the administration of extra oxygen during the procedure can contribute to carbon dioxide production. Anesthesiologists should be mindful of minimizing unnecessary oxygen use and adopting eco-friendly practices wherever possible.

Overall, the goal is to achieve successful RA blocks that provide pain relief, allow for efficient surgical procedures, and prioritize patient safety while also considering environmental sustainability and minimizing potential complications.

  • Regional Anaesthesia
  • success
  • blocks

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