Regional anesthesia for orthopedic procedures: What orthopedic surgeons need to know

Abstract

Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary. Lower extremity peripheral nerve blocks include femoral nerve block, saphenous nerve block, sciatic nerve block, iPACK block, ankle block and lumbar plexus block. The choice of regional anesthesia is a unanimous decision made by the surgeon, the anesthesiologist, and the patient based on a risk-benefit assessment. The choice of the regional block depends on patient cooperation, patient positing, operative structures, operative manipulation, tourniquet use and the impact of post-operative motor blockade on initiation of physical therapy. Regional anesthesia is safe but has an inherent risk of failure and a relatively low incidence of complications such as local anesthetic systemic toxicity (LAST), nerve injury, falls, hematoma, infection and allergic reactions. Ultrasound should be used for regional anesthesia procedures to improve the efficacy and minimize complications. LAST treatment guidelines and rescue medications (intralipid) should be readily available during the regional anesthesia administration.

Keywords: Adductor canal; Ankle; Axillary; Block failure; Brachial plexus; Combined spinal epidural; Complication; Continuous nerve block catheters; Epidural; Fascia iliaca; Femoral; Infraclavicular; Interscalene; Local anesthetic systemic toxicity; Lower extremity; Lumbar plexus; Nerve injury; Neuraxial blocks; Orthopedic surgery; Peripheral nerve blocks; Popliteal; Regional anesthesia; Saphenous; Sciatic; Spinal; Supraclavicular; Upper extremity; iPACK.