Rejyonel Anestezi
Synopsis
In this study, the anatomical, mechanism of action, indication, contraindication, and complication characteristics of neuraxial blocks (spinal, epidural, caudal) and peripheral nerve blocks, which are regional anesthesia techniques, are explained. Neuraxial blocks are safely preferred in surgeries below the neck level and especially in obstetric anesthesia by reducing maternal morbidity. These blocks have been shown to reduce the risk of venous thromboembolism, cardiac complications, bleeding amount, and surgical recurrence rates. The spinal cord terminates at the L1 level in adults and L3 in children; sympathetic, sensory, and motor block develops upon administration of local anesthetics into the subarachnoid or epidural space. While spinal anesthesia is generally performed at the L4-L5 level using a midline or paramedian approach, the epidural space is accessed using loss of resistance or hanging drop methods in epidural anesthesia. Patient refusal, bleeding diathesis, severe hypovolemia, increased intracranial pressure, severe aortic/mitral stenosis, and local infection constitute absolute contraindications. In patients taking anticoagulants, drug withdrawal intervals should be followed in accordance with ASRA guidelines and consultation should be performed. Complications include headache, urinary retention, hypotension, hematoma, and nerve injury. Peripheral nerve blocks are performed under ultrasound and nerve stimulator guidance. While brachial plexus blocks (interscalene, supraclavicular, infraclavicular, axillary) are used for upper extremity surgeries, femoral, lateral femoral cutaneous, obturator, psoas compartment, saphenous, sciatic, and transversus abdominis plane (TAP) blocks are successfully applied for lower extremity and abdominal procedures.
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