Local infiltration - injection of an agent directly into tissue around an incision, wound, or lesion. Used for suturing.
May be used when general anesthesia cannot be used because of a disease, pt has had reaction to general anesthesia, pt's choice, or pain management is enhanced by regional anesthesia -- still have gag reflex.
Regional Anesthesia Field Block
Occurs with a series of injections around the operative field. Used for chest procedures, hernia repairs, dental surgery & some plastic surgeries.
Regional Anesthesia Nerve Block
Occurs with injection of local anesthetic agent into or around a nerve or group of nerves. Used for example after rotator cuff repair.
Regional Anesthesia Spinal Anesthesia
AKA intrathecal block. Occurs by injecting an anesthetic agent into cerebrospinal fluid in subarachnoid space. It is used for lower abdominal & pelveic surgery.
Regional Anesthesia Epidural Anesthesia
Injected into epidural space & spinal cord areas are never entered. Use for vaginal, hip & lower extremity surgeries. Two advantages are decreased cardiac & pulmonary complications which are especially important for older pt & use of epidural catheter for pain control after surgery.
Complications of Local or Regional Anesthesia
Incorrect placement or delivery technique
Nurse assesses for CNS stimulation followed by CNS & cardiac depression which are signs of a system toxic reaction.
Nurse observes for blurred vision, H/A, incoherent speech, metallic taste, N/V, siezures, & an increase in vital signs.
If untreated, death may occur.
Interventions - establish an airway, giving oxygen, notify surgeon
Administration of sedative, hypnotic, & opiod meds to produce a condition in which the pt has a depressed level of consciousness but retains ability to independently maintain a patent airway & respond appropriately to verbal commands & physical stimulation
Versed (midazolam), Valium
Autologous blood transfusion
R/F infection R/T break in skin integrity
R/F disuse syndrome R/T immobilization
Ineffective thermoregulation R/T medications
Client Safety / Interventions
Positioning - pad under bony prominances, maintain good alignment