Also known as block anesthesia,[1] conduction anesthesia differs from general anesthesia in that it affects a specific part of the body and that patients may remain awake during the procedure. Conduction anesthesia is a comprehensive term which encompasses a variety of local and regional anesthetic techniques. While there is a spectrum of complexity between simple local anesthetic infiltration and major regional blocks, such as the 'central neuraxial blocks' (spinal and epidural), the terms local anesthesia, regional anesthesia, and conduction anesthesia are often all used interchangeably.
Contents
- 1 Indications and applications
- 2 Regional anesthesia
- 3 Local anesthesia
- 4 Non-medical conduction anesthetic techniques
- 5 See also
- 6 References
- 7 External links
Indications and applications
The aim of local anesthesia or regional anesthesia is generally to induce local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with reduced pain and distress. In many situations, such as cesarean section, it is considered safer and therefore preferred to general anesthesia.[2] It is also used for relief of non-surgical pain and to enable diagnosis of the cause of some chronic pain conditions.[3] Anesthetists sometimes combine both general and local anesthesia techniques.
Regional anesthesia
Regional anesthesia is anesthesia affecting a large part of the body, such as a limb or the lower half of the body. Regional anesthetic techniques can be divided into central and peripheral techniques. The central techniques include so called neuraxial blockade (epidural anesthesia, spinal anesthesia). The peripheral techniques can be further divided into plexus blocks such as brachial plexus blocks, and single nerve blocks. Regional anesthesia may be performed as a single shot or with a continuous catheter through which medication is given over a prolonged period, e.g. continuous peripheral nerve block (CPNB). Regional anesthesia can be provided by injecting local anesthetics directly into the veins of an arm (provided the venous flow is impeded by a tourniquet.) This is called intravenous regional techniques (Bier block).
Unlike a minor local anesthetic infiltration to allow a wound to be sutured, or a skin lesion to be excised, regional anesthesia may involve large doses of local anesthetic, or administration of the local anesthetic very close to, or directly into the central nervous system. Therefore there is a risk of complications from local anesthetic toxicity (such as seizures and cardiac arrest) and for a syndrome similar to spinal shock. Research suggests that this risk is rare, at less than 0.04%.[4]
Local anesthesia
| Conduction anesthesia |
| Intervention |
| MeSH |
D000772 |
Local anesthesia, in a strict sense, is anesthesia of a small part of the body such as a tooth or an area of skin. Common techniques include topical anesthesia (surface), and local infiltration[5]
Adverse effects depend on the local anesthetic agent, method, and site of administration and is discussed in depth in the local anesthetic sub-article, but overall, adverse effects can be:
- localized prolonged anesthesia or paresthesia due to infection, hematoma, excessive fluid pressure in a confined cavity, and severing of nerves & support tissue during injection.[6]
- systemic reactions such as depressed CNS syndrome, allergic reaction, vasovagal episode, and cyanosis due to local anesthetic toxicity.
- lack of anesthetic effect due to infectious pus such as an abscess.
Non-medical conduction anesthetic techniques
Local pain management that uses other techniques than analgesic medication include:
- Transcutaneous electrical nerve stimulation, which has been found to be ineffective for lower back pain, however, it might help with diabetic neuropathy.[7]
- Pulsed radiofrequency, neuromodulation, direct introduction of medication and nerve ablation may be used to target either the tissue structures and organ/systems responsible for persistent nociception or the nociceptors from the structures implicated as the source of chronic pain.[8][9][10][11][12]
See also
Anesthesia
Local anesthetic
Continuous wound infiltration
References
- ^ "The American Heritage® Stedman's Medical Dictionary.". Dictionary.com. Houghton Mifflin Company.
- ^ Afolabi, Bosede B., F. E. Lesi, and Nkihu A. Merah. "Regional versus general anesthesia for caesarean section." Cochrane Database Syst Rev 4 (2006): 350.
- ^ COFIELD, ROBERT H. M.D.; NESSLER, JOSEPH P. M.D.; WEINSTABL, REINHARD M.D. (June 1993). "Diagnosis of Shoulder Instability by Examination Under Anesthesia". Current OrthoPaedic Practice 291.
- ^ Brull, Richard, et al. "Neurological complications after regional anesthesia: contemporary estimates of risk." Anesthesia & Analgesia 104.4 (2007): 965-974.
- ^ Malamed, Stanley F. Handbook of local anesthesia. Elsevier Health Sciences, 2004.
- ^ "Nerve damage associated with peripheral nerve block" (PDF). Risks associated with your anaesthetic, (The Royal College of Anaesthetists). Section 12. January 2006. Retrieved 2007-10-10.
- ^ Dubinsky RM, Miyasaki J (January 2010). "Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology". Neurology 74 (2): 173–6. doi:10.1212/WNL.0b013e3181c918fc. PMID 20042705.
- ^ Varrassi G, Paladini A, Marinangeli F, Racz G (2006). "Neural modulation by blocks and infusions". Pain practice : the official journal of World Institute of Pain 6 (1): 34–8. doi:10.1111/j.1533-2500.2006.00056.x. PMID 17309707.
- ^ Meglio M (2004). "Spinal cord stimulation in chronic pain management". Neurosurg. Clin. N. Am. 15 (3): 297–306. doi:10.1016/j.nec.2004.02.012. PMID 15246338.
- ^ Rasche D, Ruppolt M, Stippich C, Unterberg A, Tronnier VM (2006). "Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience". Pain 121 (1–2): 43–52. doi:10.1016/j.pain.2005.12.006. PMID 16480828.
- ^ Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L (2007). "Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain" (PDF). Pain physician 10 (1): 7–111. PMID 17256025.
- ^ Romanelli P, Esposito V, Adler J (2004). "Ablative procedures for chronic pain". Neurosurg. Clin. N. Am. 15 (3): 335–42. doi:10.1016/j.nec.2004.02.009. PMID 15246341.
External links
- New York School of Regional Anesthesia
- Anesthesia Books
- General information and tutorials in peripheral regional anesthesia
- [1] Free online manual of regional anaesthesia- John Hyndman
- Clinical Use of Peripheral Nerve Stimulators and The Neuromuscular Junction
- ESRA - The European Society for Regional Anaesthesia Congress
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Anesthesia (outline)
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| Types |
- General
- Spinal
- Epidural
- Conduction anesthesia
- Local
- Topical
- Intercostal nerve block
- Sedation / Twilight anesthesia
- Dental (Inferior alveolar nerve)
- Neuroleptanalgesic anesthesia
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| Techniques |
- Airway management
- Anesthesia provision in the US
- Arterial catheter
- Bronchoscopy
- Capnography
- Dogliotti's principle
- Drug-induced amnesia
- Intraoperative neurophysiological monitoring
- Nerve block
- Penthrox inhaler
- Tracheal intubation
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| Scientific Principles |
- Blood–gas partition coefficient
- Concentration effect
- Fink effect
- Minimum alveolar concentration
- Second gas effect
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| Measurements |
- ASA physical status classification system
- Baricity
- Bispectral index
- Direct Fick method
- Entropy monitoring
- Fick principle
- Goldman index
- Guedel's classification
- Mallampati score
- Neuromuscular monitoring
- Thyromental distance
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| Instruments |
- Anaesthetic machine
- Anesthesia cart
- Boyle's machine
- Gas cylinder
- Laryngeal mask airway
- Laryngeal tube
- Medical monitor
- Odom's indicator
- Relative analgesia machine
- Vaporiser
- Double-lumen endotracheal tube
- Endobronchial blocker
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| Drugs |
- Benzodiazepine
- Etomidate
- General anaesthetic
- Inhalational anaesthetic
- Infiltration analgesia
- Ketamine
- Local anesthetic
- Methohexital
- Methoxyflurane
- Midazolam
- Neuraxial blockade
- Opiate
- Propofol
- Thiopental
- Thiopentone
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| Complications |
- Emergence delirium
- Allergic reactions
- Anesthesia awareness
- Local anesthetic toxicity
- Malignant hyperthermia
- Perioperative mortality
- Postanesthetic shivering
- Postoperative nausea and vomiting
- Postoperative residual curarization
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| Fields of study |
- Cardiothoracic
- Geriatric
- Oral sedation dentistry
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| Professions |
- Anesthesiologist
- Anesthesiologist assistant
- Nurse anesthetist
- Operating Department Practitioners
- Certified Anesthesia Technician
- Certified Anesthesia Technologist
- Anaesthetic technician
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| History |
- A.C.E. mixture
- Helsinki Declaration for Patient Safety in Anaesthesiology
- History of general anesthesia
- History of neuraxial anesthesia
- History of tracheal intubation
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| Organizations |
- American Association of Nurse Anesthetists
- American Society of Anesthesia Technologists & Technicians
- American Society of Anesthesiologists
- Anaesthesia Trauma and Critical Care
- Association of Anaesthetists of Great Britain and Ireland
- Association of Veterinary Anaesthetists
- Australian and New Zealand College of Anaesthetists
- Australian Society of Anaesthetists
- International Anesthesia Research Society
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