Regional Anesthesia

Introduction

The management of postoperative pain in the ambulatory surgical setting can be challenging. The use of regional anesthetic techniques, along with multimodal systemic analgesics and pain risk stratification, can be of significant benefit in postoperative analgesia.

Our goal at SAMBA is to provide our members with concise, up-to-date, and evidence-based information that can be of help with regional anesthesia education and clinical decision-making.

Please keep in mind that responsibility for all regional anesthetic techniques and clinical decisions ultimately rests with the clinician.

Regarding regional anesthetic techniques, many members have found in-person training to be most beneficial. If you would like to practice hands-on scanning for “must-know” blocks, we encourage you to attend the ultrasound workshops at our annual SAMBA meeting

Acute and Chronic Pain in the Ambulatory Setting
-Perioperative Systemic and Chronic Pain Management

Ultrasound-Guided Regional Anesthesia

The Basics of Ultrasound
-New to ultrasound? Check out these resources to help you get acquainted with the basics! 
-Ultrasound Basics
-Ultrasound Quick Reference for Peripheral Nerve Blocks
-Basic Blocks Image Bank (2018)

Upper Extremity Peripheral Nerve Blocks – What you need to know - Brachial Plexus Blocks

Lower Extremity Peripheral Nerve Blocks – What you need to know - Lower Extremity Blocks

Common (and not-so-common) Troubleshooting Issues
What do you do when a patient calls back complaining of a leaking nerve catheter? When do they need to come back for the surgical center for an in-person evaluation?

Fear not, the following tip sheet may be of use:
-Troubleshooting Nerve Catheters and Blocks

Anticoagulants and Regional Anesthesia
For neuraxial techniques, deep plexus blocks, and peripheral nerve blocks at non-compressible sites, it is useful and necessary to be familiar with the most recent recommendations regarding anticoagulation. While use of an epidural catheter may be uncommon in ambulatory anesthesia, spinal anesthetics may be beneficial in certain surgeries and in patients with certain comorbidities.

The following is a guideline based on the most recent recommendations of the American Society of Regional Anesthesia (ASRA) and European Society of Regional Anesthesia (ESRA). While intended as a quick-reference, please also refer to the most recent electronic recommendations from these societies as needed.

SAMBA Neuraxial Anticoagulant Guideline 2018