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Monitoring regional blockade
Author(s) -
Ode K.,
Selvaraj S.,
Smith A. F.
Publication year - 2017
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.13742
Subject(s) - medicine , blockade , neuraxial blockade , regional anaesthesia , general anaesthesia , block (permutation group theory) , referral , nerve block , neuromuscular blockade , intensive care medicine , modalities , anesthesia , surgery , receptor , geometry , mathematics , family medicine , spinal anesthesia , social science , sociology
Summary This review attempts to draw on the published literature to address three practical clinical questions. First, what means of testing the degree of regional blockade pre‐operatively are available, and can eventual success or failure be determined soon after injection? Second, is it possible to predict if a block inserted after the induction of general anaesthesia will be effective when the patient wakes? Third, what features, and what duration, should cause concern when a block does not resolve as expected after surgery? Although the relevant literature is limited, we recommend testing of multiple sensory modalities before surgery commences; temperature and thermographic changes may offer additional early warning of success or failure. There are a number of existing methods of assessing nociception under general anaesthesia, but none has yet been applied to gauge the onset of a regional block. Finally, criteria for further investigation and neurological referral when block symptoms persist postoperatively are presented.