Regional blocks under deep sedation: a review
Prof. Peter Marhofer of the Department of General Anaesthesia and Intensive Care Medicine at the Medical University of Vienna conducted this review on regional anesthesia in sedated or anesthetized patients. In the expert’s view, more patients would accept the blocks if they were sedated or under general anesthesia.
According to current literature,
complications of regional blocks are rare,
awake patients will notice only a minority of needle-to-nerve contacts, the notion of a “live monitor” is therefore obsolete,
needle-to-nerve contact or intraepineural injection of local anesthetic can be avoided with high-resolution ultrasound,
cases of intoxication are rare and might manifest quicker when the patient is awake. However, some general anesthesia drugs reduce the seizure-inducing potency of local anesthetics. In addition, hemodynamic signs of intoxication can also be detected under general anesthesia.
Neuraxial and peripheral regional blocks in sedated or anesthetized patients are a “reasonable option”, summarizes Peter Marhofer. Ultrasound guidance and most importantly the right set of skills of the anesthetist are crucial to conduct the block procedure safely and effectively.