PS03 Guidelines for the Management of Major Regional Analgesia

Abstract

This document is intended to apply to central neuraxial blocks and all other techniques where a catheter is inserted and left in situ, or where a significant dose of local anaesthetic is administered, such that systemic toxicity may occur due to absorption or inadvertent intravascular injection. It is not primarily intended to include superficial peripheral nerve blocks such as facial or digital nerve blocks, or low volume local anaesthetic procedures such as small areas of skin infiltration, although many of the principles may still apply. The purpose of these guidelines is to facilitate the management of major regional blocks including epidural, subarachnoid, plexus and nerve blocks, and to reduce the likelihood of adverse outcomes and complications which may be associated with such blocks including, but not limited to, cardiovascular collapse, seizures, hypotension, allergic reactions, ventilatory impairment, impaired consciousness, haematoma, infection, abscess and nerve damage. The guidelines also outline practices to minimise the risk of wrong site block. Major regional analgesia may be initiated for pain management alone, such as providing analgesia in labour or in the perioperative setting for the provision of perioperative analgesia. This may be combined with, but is distinct from, regional anaesthesia which is initiated for surgical interventions and which requires continuous presence of an anaesthetist (see PS53 Statement on the Handover Responsibilities of the Anaesthetist). In some instances analgesia may follow on from anaesthesia as a continuation of the technique.