Complications of Regional Anesthesia: Principles of Safe Practice in Local and Regional Anesthesia

494 Pages·2017·17.04 MB·English

by  Brendan T. Finucane

Brendan T. Finucane
Ban C.H. Tsui
Editors
Complications of
Regional Anesthesia
Principles of Safe Practice in
Local and Regional Anesthesia
Third Edition
123
Complications of Regional Anesthesia
Brendan T. Finucane • Ban C.H. Tsui
Editors
Complications of Regional
Anesthesia
Principles of Safe Practice
in Local and Regional Anesthesia
Third Edition
Editors
Brendan T. Finucane, MB, BCh, BAO, FRCA, Ban C.H. Tsui, MSc (Pharm), MD, FRCPC
FRCPC Department of Anesthesiology,
Department of Anesthesiology Perioperative and Pain Medicine
and Pain Medicine University of Alberta Stanford University School of Medicine
Edmonton, AB, Canada Stanford, CA, USA
Originally published by Churchill Livingstone, New York City, 1999
ISBN 978-3-319-49384-8 ISBN 978-3-319-49386-2 (eBook)
DOI 10.1007/978-3-319-49386-2
Library of Congress Control Number: 2017933835
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We would like to dedicate this edition of the book to our patients, our teachers,
our students, and our families.
Brendan T. Finucane, MB, BCh, BAO, FRCA, FRCPC
Ban C.H. Tsui, MSc (Pharm), MD, FRCPC
Preface
We are now ready to publish the third edition of Complications of Regional Anesthesia which
was first published 17 years ago. The title remains the same but we have added the subtitle,
Principles of Safe Practice in Local and Regional Anesthesia, to stress the relatively new empha-
sis and importance on safety and prevention and to broaden our horizons to include some discus-
sion about the practice and the administration of not just Regional but also Local Anesthesia.
We have made some significant changes to the book which we hope you approve. First of
all this is a much more comprehensive edition going from 24 to 35 chapters, and we have also
divided the book into seven separate parts based mostly on logic. In the opening part entitled
General considerations, we started out with a chapter on the History of Regional Anesthesia
which seemed like a good place to start. We also addressed the issue of Safety of Regional
Anesthesia. It is difficult to discuss much about regional and local anesthesia without mention-
ing toxicity of local anesthetics which has been a problem with regional and local anesthesia
since its inception more than 130 years ago, and we finished up that section with a good discus-
sion of Outcomes comparing Regional and General Anesthesia. In the second part we addressed
Special considerations, which includes a chapter on Mechanisms of Nerve injury, Infection,
Catheter techniques, and the whole issue of regional anesthesia in the presence of neurologic
disease and how to evaluate neurologic injury following regional anesthesia. We then dedi-
cated several chapters to Specific blocks involving anatomic regions of the body specifically
addressing safety and management of adverse events. We dedicated the next part to specific
Patient Populations—the young, the old, the pregnant, obese, and those suffering from
chronic pain. The next part is new territory for us and is entitled Special Environments. We
invited a group of practitioners, mostly surgeons, who frequently use local anesthetics in their
practices, to share their expertise and experiences with us. Among this group of specialists are
dentists, ophthalmologists, emergency room physicians, orthopedists, and plastic surgeons.
We have a lot to learn by sharing our experiences using local and regional anesthesia with
specialists outside our own discipline and they from us. We dedicated a part to Morbidity
Studies and this part includes writers from across the world adding an International flavor, as
we are sometimes accused of being too insular in North America. We dedicated the final part
to Medical Legal Aspects of Local and Regional Anesthesia, which we must realistically face
in the modern world of this twenty-first century.
Labat, in the 1920s, was the first fully trained specialist in Regional Anesthesia, and he
influenced the leaders of this new emerging specialty of anesthesiology to use regional anes-
thesia in their practices. Most anesthesiologists at that time opted for general anesthesia
because of its predictability. Tremendous advances have been made in Regional Anesthesia in
the past 30 or 40 years, so much so that most anesthesiologists in the modern era have become
interested in regional anesthesia again because there is far more predictability in the practice
of regional anesthesia than ever before. We can now actually see what we are doing instead of
blindly seeking neural targets, based on our knowledge of anatomy. Most anesthesiologists
fully appreciate the enormous benefits of regional anesthesia to patients especially in the post-
operative period but also long term. However, despite good practice, we encounter problems
vii
viii Preface
and unforeseen circumstances, so practitioners must be fully aware of the many pitfalls and
complications associated with the practice of regional anesthesia even though we have made
enormous advances in recent years.
This edition is much more comprehensive than our previous efforts and more inclusive and
there are more pages, tables, diagrams, and colored illustrations. This text is also comprehen-
sively referenced. As in previous editions, there is some repetition and that is inevitable.
However, it is refreshing to compare anesthesia practitioners’ experiences from around the
world and from outside our own discipline. Local Anesthetic Systemic Toxicity (LAST) is a
very common theme among all who practice Local and Regional Anesthesia, and we have
learned a lot about prevention and treatment of this malady in the past 30 years. Fortunately
most of the complications we have discussed are rare and all too often we appear to shoulder
the blame for injuries that we did not cause in the first place.
Our main emphasis is on safety and prevention of injury in the practice of local and regional
anesthesia, and we have called upon a great variety of experts from around the world to share
their experiences with us. We hope you appreciate the changes we have and as always we wel-
come your critique and recommendations for improvement.
There is one other important change I have made in this edition and that is I have invited my
colleague and friend from the Department of Anesthesiology and Pain Medicine from the
University of Alberta to co-edit this edition of the text with me. He has contributed enormously
to our knowledge of local and regional anesthesia in the past two decades and helped a great
deal with this latest version.
Edmonton, AB, Canada Brendan T. Finucane
Stanford, CA, USA Ban C.H. Tsui
Acknowledgments
We would like to express our deep gratitude to all of the contributors to this text. We are
impressed by the quality of the material presented and their willingness to abide by all of the
rules imposed. We also wish to thank a group of students, medical students, fellows, and
research assistants over the past 2 years, including Gareth Corry, Saadat Ali, and Jeremy Tsui,
who assisted in organizing the written material. An investigator grant from the Alberta Heritage
Foundation for Medical Research allowed Dr. Tsui to pursue this project by helping to support
his academic work.
Acknowledgments
Brendan T. Finucane, MB, BCh, BAO, FRCA, FRCPC
I would like to acknowledge some special individuals who greatly influenced my career in
anesthesia, academic medicine, and my passion for regional anesthesia. These are Dr. John
Shanahan, Dr. Tom Bryson, Professors T Cecil Gray, John E Steinhaus, Evan Frederickson,
Pritvi Raj, and Ben Covino.
Acknowledgments
Ban C.H. Tsui, MSc (Pharm), MD, FRCPC
To my wife, Eliza, and my children, Jenkin and Jeremy—the real loves of my life. Without
their support and understanding, I could not have completed this demanding project. I would
also like to dedicate this opus to my parents, Woon-Tak and Kau-Wan, for their love and guid-
ance throughout my life.
Brendan T. Finucane
Ban C.H. Tsui
ix
Contents
Part I General Considerations
1 The History of Local and Regional Anesthesia ..................................................... 3
Brendan T. Finucane
2 Regional Anesthesia Safety ...................................................................................... 15
John W.R. McIntyre and Brendan T. Finucane
3 Local Anesthetic Toxicity: Prevention and Management ..................................... 41
Derek Dillane
4 Outcome Studies Comparing Regional and General Anesthesia ........................ 55
Brian O’Donnell and Michael O’Sullivan
Part II Special Considerations
5 Nerve Injury Resulting from Intraneural Injection When Performing
Peripheral Nerve Block ........................................................................................... 67
Rakesh V. Sondekoppam and Ban C.H. Tsui
6 Regional Anesthesia in the Presence of Neurologic Disease ................................. 103
John Shepler, Andrea Kattula, and George Arndt
7 Evaluation of Neurologic Injury Following Regional Anesthesia ........................ 113
Quinn Hogan, Keith McCollister, Matthew Harmelink, Laura Kohl,
and Michael Collins
8 Regional Anesthesia and Anticoagulation .............................................................. 139
Robert B. Bolash and Richard W. Rosenquist
9 Infection in Association with Local and Regional Anesthesia .............................. 149
Terese T. Horlocker, Denise J. Wedel, and Adam D. Niesen
10 Continuous Peripheral Nerve Blocks Safe Practice and Management ............... 167
Geert-Jan van Geffen and Jörgen Bruhn
Part III Specific Regional Blocks: Safe Practice and Management
of Adverse Events
11 Complications of Regional Anesthesia: Upper and Lower Extremity
Blockade .................................................................................................................... 189
Stephen Choi, Patrick B.Y. Wong, Kristen Gadbois, and Colin J.L. McCartney
12 Complications of Thoracic Wall Regional Anesthesia and Analgesia ................. 199
Christine Lee and F. Michael Ferrante
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xii Contents
13 Abdominal Wall Blocks: Safe Practice and Management of Adverse Events .... 219
James D. Griffiths and Peter D. Hebbard
14 Epidural Blockade: Safe Practice and Management of Adverse Events ............ 227
Steven J. Gaff
15 Spinal Anesthesia: Safe Practice and Management of Adverse Events .............. 245
Pekka Tarkkila
Part IV Specific Patient Populations: Safe Practice and Management
of Adverse Events
16 Complications of Regional Anesthesia in Chronic Pain Therapy ........................ 261
David Flamer, Rachael Seib, and Philip W.H. Peng
17 Local and Regional Anesthesia in the Elderly ....................................................... 287
Ferrante S. Gragasin and Ban C.H. Tsui
18 Local and Regional Analgesia for Labor and Delivery ........................................ 303
Yoo Kuen Chan and Peng Chiong Tan
19 Local and Regional Anesthesia in the Obese Patients .......................................... 319
Hendrikus J.M. Lemmens
20 Local and Regional Anesthesia in Pediatrics ......................................................... 327
Belen De Jose Maria
Part V Special Environments: Safe Practice and Management
of Adverse Events
21 Local and Regional Anesthesia in Dental and Oral Surgery ............................... 341
Stanley F. Malamed, Kenneth L. Reed, Amanda Okundaye, and Andrea Fonner
22 Local and Regional Anesthesia in the Emergency Room ..................................... 359
Andrew A. Herring
23 Recognizing and Mitigating Risk of Ophthalmic Regional Anesthesia .............. 369
Brad Wakeman, Robert William Andrew Machuk, Rizwan Somani,
Dean Y. Mah, and Ian M. MacDonald
24 Local Infiltration Analgesia for Orthopedic Joint Surgery ................................. 381
Sugantha Ganapathy, James L. Howard, and Rakesh V. Sondekoppam
25 Local and Regional Anesthesia in Plastic Surgery: Safety Considerations
and Management of Adverse Events ...................................................................... 399
John Mesa, Don Lalonde, and Luis O. Vasconez
Part VI Morbidity Studies: International Perspective
26 Development and Methodology of a Registry of Regional Anaesthesia .............. 413
Michael J. Barrington
27 Australia: Results of a Multicenter Registry of Regional Anesthesia ................. 421
Michael J. Barrington
28 Canada: Medical Legal Aspects of Regional Anesthesia Practice ....................... 429
Kari G. Smedstad and Brendan T. Finucane