Regional Anaesthesia for Wound Repair Dr Meehar M Shah Chelsea and Westminster Hospital Jan 2015

Outline Briefly discuss LA pharmacology Discuss relevant anatomy from head to toe Discuss landmark and USS techniques

Local Anaesthetics Inhibit neuronal Na+ channels to block depolarisation Know the common types in your department- Lidocaine, Bupivacaine, Prilocaine, Ropivacaine Additives Safe doses, contraindications Local and systemic toxicity of these agents Management of toxicity

Principles Use small gauge needles (25/27G) Raise wheel first then advance for deeper blocks Slow aspiration and injection Withdraw if severe pain on injection Give it time to work – repeat/infiltrate if inadequate

Sensory blocks of the Face Useful as local infiltration can distort anatomy complicating accurate repair Reduce overall LA dose vs infiltration Need to understand Trigeminal nerve anatomy for success

Blocks Supra/infraorbital nerve Supra/infratrochlear nerve External nasal nerve Mental nerve Field block of ear

Upper Limb Blocks Median, Radial and Ulnar nerve blocks Digital nerve blocks Axillary blocks for more extensive injuries (US guided)

Axillary Block

Foot and Ankle Blocks

Conclusions Know your anatomy!! Explain risks/benefits clearly to patient Use US if competent to do so (but don’t overcomplicate things either!) Consider longer acting LA for post procedure pain relief also Educate patients on discharge if still numb (avoid hot drinks etc)