Dr S Parthasarathy MD DA DNB MD Acu Dip Diab DCA Dip Software statis tics PhDphysiology Mahatma Gandhi medical college and research institute puducherry India ID: 1045295
Download Presentation The PPT/PDF document "Intravenous regional anaesthesia" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. Intravenous regional anaesthesia Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software statistics PhD(physiology)Mahatma Gandhi medical college and research institute, puducherry, India
2. History Intravenous regional anaesthesia (IVRA) was first described by August Bier in 1908. He observed that when local anaesthetic was injected IV between two tourniquets on a limb, a rapid onset of anaesthesia in between the tourniquets and a slower onset occurred beyond the distal tourniquet. Not popular until the 1960s when it was reintroduced by Holmes.
3. Original inter cuff IVRA1st cuff2nd cuff
4. Double tourniquet
5. Indications surgical interventions on the hand, forearm or elbow that will not exceed 1 hour. These include manipulation of forearm fractures, excision of wrist ganglia and palmar fasciotomy.the foot, ankle or lower leg, for example - for removing plates, screws or foreign bodies
6. contraindicationsTo tourniquet sickle cell disease, Raynaud’s disease or sclerodermaAllergy to local anaestheticsperipheral vascular diseaseSurgery needs tourniquet removal during the procedure
7. Advantages Ease of performanceSafetyOnset Relaxation Controlled duration Rapid recovery Definite -- successful anaesthesia in 96–100%
8. Disadvantages Use of tourniquet Cannot release tourniquet Exsanguination Toxic reactions Duration ??
9. Technique - equipmentEsmarch bandage Tourniquet – single or double ?? Two IV accessesRoutine resuscitative equipmentLocal anaesthetics
10. Preparation Explanation IV access both sides Benzodiazepine premed oral Vein on the dorsum of hand access before tourniquet Exsanguination
11. exsanguinationEsmarch bandage or a Rhys-Davis exsanguinator.Crepe bandageelevating the arm for 2–3 minutes while compressing the axillary arteryit must be confirmed that no radial pulse is palpable before IV
12. Rhys-Davis exsanguinator.
13. Tourniquet applicationThe double tourniquet (two tourniquets each 6 cm wide) or a single one (14 cm wide) is applied on the arm with generous layers of padding, no wrinkles are formed tourniquet edges do not touch the skin
14. Inflation Proximal touniquet 30 mm above systolic Better to have it as 200 mmHg Legs can go upto 300 mmHg
15. Tourniquet Discomfort Minimum time Release ?? Test deflation and reinflation Resuscitation ready No movement after release
16. double cuff tourniquetIf using a double cuff tourniquet, the distal cuff should be deflated. If required for tourniquet pain control, the distal cuff may be inflated, followed by deflation of the proximal cuff. Check for inflation by palpation of the tourniquet cuff.
17. Find LOP and inflate LOP can be defined as the minimum pressure required, at a specific time in a specific tourniquet cuff applied to a specific patient’s limb at a specific location, to stop the flow of arterial blood into the limb distal to the cuffInflate 100 mm above LOP
18. drugsPrilocaine 0.5 % 40 to 50 ml Lignocaine 0.5 % 40 to 50 ml Ropivacaine , Bupivacaine used Legs upto 70 – 80 ml ..dose -- slim??Preservative free LAOver 90 seconds Chase the LA with NS No adrenaline
19. Anaesthesia is --Anaesthesia is terribly simpleBut sometimes It is simply terrible
20. Modified methods Hand Legs Foot Children Dose and size of cuff
21.
22. Complications CNS symptoms 2.1 % to 10 % incidence CVS 15 % ECG changes ?? Minimal drop in BP and HR Dose and preinj. IschemiaHigher levels of local anaesthetic in blood after axillary and lumbar epidural blocks
23. Cross section of nerve fibre Mantle Proximal areaBrachial blocksCore = distal or digital- IVRAMantle Core Vasa nervorum
24. Mechanism Digits first even in intercuff method nerves near the elbow (especially the median and ulnar nerves) are known to be closely accompanied by veins, tributaries of which mainly run through the core of each nerve trunk.nerve trunks are constructed with fibres from the periphery nearest the centre
25. Difference centripetal spread of the anaesthetic effect.Nerve blocks have centrifugal anaesthetic effect because the drug is poured into the nerve from outside
26. IVRA and additives OpioidsRelaxants Ketamine Clonidine Neostigmine Paracetamol Ketoroloc
27. IVRA and sympatholytics Guanithidine 10 – 20 mg with 500 units heparin with 20 – 30 ml physiological salineDiagnostic sympathetic block TAO , CRPS etc..
28. Summary Easy simple method 100 % efficacy Very less complicationsCheapAdjunct to brachial plexus block ??But still infamous
29. Helping others is ultimate happiness Thank you all