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Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know

Kamel, Ihab
; 
Ahmed, Muhammad F.
; 
Sethi, Anish
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Genre
Journal article
Date
2022-01-18
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Committee member
Group
Department
Anesthesiology
Subject
Orthopedic surgery
 Regional anesthesia
 Spinal
 Epidural
 Combined spinal epidural
 Peripheral nerve blocks
 Neuraxial blocks
 Upper extremity
 Lower extremity
 Interscalene
 Supraclavicular
 Infraclavicular
 Axillary
 Femoral
 Fascia iliaca
 Popliteal
 Sciatic
 Saphenous
 Adductor canal
 Lumbar plexus
 Brachial plexus
 Ankle
 iPACK
 Complication
 Local anesthetic systemic toxicity
 Nerve injury
 Block failure
 Continuous nerve block catheters
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http://hdl.handle.net/20.500.12613/9297
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KamelEtAl-JournalArticle-2022-01.pdf
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http://dx.doi.org/10.5312/wjo.v13.i1.11
Abstract
Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.
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Citation
Kamel I, Ahmed MF, Sethi A. Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know. World J Orthop 2022; 13(1): 11-35
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Baishideng Publishing Group
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World Journal of Orthopedics, Vol. 13, Iss. 1
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