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Why should we do them ?
How effective are they ?
What are the limitations ?
What drugs are available ?
What are the risks ?

The technique behind the femoral,

femoral, ankle
and a wrist blocks
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are excellent for providing prolonged
anaesthesia and analgesia

are generally safe and easy to perform

require very little equipment or set up time

allow for minor procedures to be done outside of

theatre without the need for general anaesthesia

 
4peed + duration depends on the local anaesthetic used,
the volume and concentration,
and whether any adjuncts used
loss of sensation develops faster than motor blockade

Onset of Duration of Duration of

action anaesthesia analgesia
Bupivacaine 0.5% 15
15--30 mins 5-15 hours 6-30 hours
(Marcain®)
Lignocaine 1.0% 10
10--20 mins 2-5 hours 3-8 hours
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!ge
Patient refusal
!llergy to local anaesthetic
4uperficial infection
Previous neurological deficit
Risk of compartment syndrome

!nkle blocks in particular are painful and may

need some iv sedation +/-
+/- short acting opiate analgesia

 

Lignocaine 1% and marcain® 0.5% plain are available

In theatres other drugs are used that are less cardiotoxic

and adrenalin is often added to increase duration and
speed of onset

Bicarbonate can also increase speed of onset and

theoretically reduce pain of injection

4ometimes other drugs are added in the theatre setting

 
Marcain® is safe at dosage below « 1 mg/kg plain
(1.5 mg/kg with adrenalin)

Marcain® 0.25% in 20mls = 50mg

Marcain® 0.5% in 20mls = 100mg

This only important when large volumes injected

ie : femoral nerve blocks

Lignocaine is safe at dosage below « 3 mg/kg plain

(5
(5--7 mg/kg with adrenalin)
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Related to ¶drug· and to ¶injection·

Haematoma - ( minimum needle insertions )

Infection - ( rare with aseptic technique )

Nerve injury - ( paraesthesia )

Toxicity - ( aspiration / vigilance )






4ome debate over significance of eliciting

paraesthesia

Nerve injury is reduced by listening to the patient

and not injecting if resistance encountered

Most accidental nerve block neuropathies resolve

over time and patients need to warned about this possible
complication




Tinnitus and tingling around lips

!gitation/anxiety
Convulsion
Coma

Cardiovascular side effects include bradycardia, decreased

myocardial contractility, atrioventricular block,
vasodilation, ventricular arrhythmia, and cardiac arrest
!naesthetics in the amide class are metabolised by the
liver and excreted by the kidneys «lignocaine dose should
be decreased in patients with liver or renal disease
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