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

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

3. 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

5. 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

6. 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

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

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

20. Axillary Block

22. Foot and Ankle Blocks

24. 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)