Precautions / Complications
Precautions: A successful regional anaesthesia procedure requires careful patient evaluation, thorough knowledge of anatomy, and precise ultrasound guidance to minimise risks.
Potential Complications: Regional anaesthesia, like any medical procedure, carries risks. Awareness and early recognition of these complications are critical to ensuring patient safety.
Management Strategy: Prompt management of complications is essential to ensuring patient safety. Early recognition, quick intervention, and proper treatment are key to mitigating risks and preventing adverse outcomes.
Detailed Learning: Proper technique, vigilant monitoring, and thorough knowledge of anatomy and ultrasound-guided regional anaesthesia techniques detailed in ARiRA can significantly reduce these risks and ensure optimal outcomes.
Rectus Sheath Block
Precautions
Ultrasound Guidance: Always use real-time ultrasound guidance to ensure accurate needle placement and avoid inadvertent injury to nearby structures, such as blood vessels or abdominal organs. This is crucial for ensuring that the local anaesthetic is delivered within the correct fascial plane.
Aspirate Before Injection: Aspirate before injecting the local anaesthetic to confirm that the needle tip is not within a blood vessel. This step is essential to prevent intravascular injection, which could lead to systemic toxicity.
Monitor Injection Pressure: If there is high resistance during the injection, it may indicate that the needle is improperly placed (e.g., intramuscularly) or that the fascial plane is not being properly filled. In such cases, stop the injection, reassess the needle position, and consider repositioning the needle.
Volume Consideration: Careful calculation of the total volume of local anaesthetic is necessary, particularly in bilateral blocks, to avoid exceeding safe dosage limits and reducing the risk of local anaesthetic systemic toxicity (LAST).
Patient Communication: If the block is performed under light sedation or with the patient awake, maintain communication to detect any unusual sensations, such as pain or discomfort, which may indicate nerve contact or incorrect needle placement.
Potential Complications
Local Anaesthetic Systemic Toxicity (LAST)
Risk: This can occur if the local anaesthetic is inadvertently injected into a blood vessel or if excessive amounts are absorbed systemically. Symptoms include dizziness, tinnitus, seizures, and cardiac arrhythmias.
Management: Immediate cessation of the injection, supportive care including airway management, and administration of intravenous lipid emulsion therapy are essential. Monitoring the patient for signs of toxicity throughout the procedure is crucial.
Infection
Risk: Infection at the injection site is possible, especially if the aseptic technique is not strictly followed.
Management: Use an aseptic technique to minimise the risk. If an infection develops, it may require treatment with antibiotics and, in severe cases, drainage of any abscess that forms.
Haematoma Formation
Risk: There is a risk of haematoma if the needle punctures the superior or inferior epigastric vessels, which are located within the rectus sheath.
Management: Careful ultrasound-guided needle placement and aspiration before injection can reduce this risk. If a haematoma forms, it may require monitoring or intervention depending on its size and severity.
Incomplete Block
Risk: If the local anaesthetic is not correctly deposited in the fascial plane, the block may be incomplete, resulting in inadequate pain relief.
Management: If necessary, repeat the injection or use additional analgesic techniques to ensure adequate pain control.
Nerve Injury
Risk: Although rare, there is a potential risk of nerve injury if the needle comes into contact with the nerves within the rectus sheath.
Management: If the patient reports sharp pain or paraesthesia during the procedure, the needle should be withdrawn and repositioned. Persistent symptoms may require further evaluation and management by a neurologist.