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Regional Anesthesia in the Critical Care Setting

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Essentials of Regional Anesthesia

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Abstract

The critically ill population represents the sickest and often among the most difficult to manage patients in the hospital. In this regard, often these patients are suffering from complex pathogenesis and often have pain states that are difficult to manage. Adequate pain control is essential in reducing the stress response during critical illness and providing analgesia to difficult disease states. Conventional opioid therapy runs the risk of developing respiratory depression, altered mental status, and reduced bowel function. Given all of these concerns, regional anesthesia can significantly benefit the patient significantly in the critical care environment.

As in many other clinical settings, a multimodal approach to pain control is recommended for the intensive care setting. The use of regional and neuraxial analgesia can play a significant role in this approach to achieve optimal pain relief, thereby reducing physiologic and psychologic stress. In addition, reduction in the utilization of opiate therapy decreases the risk for withdrawal syndrome, mental status changes, delirium, nausea and vomiting, and reduced gastrointestinal motility.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Wexner Medical Center, Ohio State University, Dublin, OH, USA

    Amir O. Elhassan MD

  2. Department of Anesthesiology and Critical Care Medicine, Louisiana State University Health Sciences Center—Shreveport, Shreveport, LA, USA

    Harish Bangalore Siddaiah MD

  3. Department of Anesthesiology, Louisiana State University Health Sciences Center—Shreveport, Shreveport, LA, USA

    Brendon M. Hart DO

  4. Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Mark Ryan Jones MD

  5. Department of Anesthesia, Tulane University, New Orleans, LA, USA

    Cory A. Roberts MD

  6. Department of Anesthesiology, School of Medicine, Louisiana State University Health Sciences Center—New Orleans, New Orleans, LA, USA

    Maura Elise Jones BS

  7. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA

    Alan David Kaye MD, PhD

Authors
  1. Amir O. Elhassan MD
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  2. Harish Bangalore Siddaiah MD
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  3. Brendon M. Hart DO
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  4. Mark Ryan Jones MD
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  5. Cory A. Roberts MD
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  6. Maura Elise Jones BS
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  7. Alan David Kaye MD, PhD
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Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Review Questions

Review Questions

  1. 1.

    The addition of epinephrine to local anesthetics for regional blockade prolongs the action of the blockade.

    1. (a)

      True

    2. (b)

      False

  2. 2.

    Peripheral nerve blocks can enhance the detection of compartment syndrome.

    1. (a)

      True

    2. (b)

      False

  3. 3.

    What is the first sign of local anesthetic toxicity in a critically ill patient?

    1. (a)

      Hypotension

    2. (b)

      Circumoral numbness

    3. (c)

      Tachycardia

    4. (d)

      Delirium

  4. 4.

    What is the first step in the treatment of local anesthetic toxicity?

    1. (a)

      Airway control with 100% oxygen

    2. (b)

      Seizure control

    3. (c)

      Reversal with 20% intralipid

    4. (d)

      None of the above

  5. 5.

    What is the 20% lipid emulsion dose for local anesthetic toxicity?

    1. (a)

      Continuous infusion of 0.25 mL/kg/min

    2. (b)

      Bolus of 2 mL/kg/min and then continuous infusion of 0.5 mL/kg/min

    3. (c)

      Bolus of 1.5 mL/kg/min then continuous infusion of 0.25 mL/kg/min

    4. (d)

      Continuous rate of 1 mL/kg/min

Answers:

  1. 1.

    a

  2. 2.

    a

  3. 3.

    b

  4. 4.

    a

  5. 5.

    c

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Elhassan, A.O. et al. (2018). Regional Anesthesia in the Critical Care Setting. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_26

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  • DOI: https://doi.org/10.1007/978-3-319-74838-2_26

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74837-5

  • Online ISBN: 978-3-319-74838-2

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