Author(s): Erica L.Gee, Joseph L.McDowell
- Preoperative assessment of the patient for regional anesthesia is similar to that for general anesthesia. The details of the procedure to be performed, including its anticipated length, patient position, and a complete review of any coexisting diseases, should be taken into account in determining the appropriateness of a regional technique.
- Review of systems: A comprehensive review of cardiovascular and pulmonary systems should be performed. Preexisting neurologic abnormalities should be well documented. Any history of abnormal bleeding and a review of the patient’s medications may indicate a need for additional coagulation studies.
- Physical examination: Review of the patient’s airway, cardiovascular, and pulmonary examinations should be performed The area where the block is to be administered should be examined for potential pathology, such as abnormal anatomy (kyphoscoliosis) or evidence of overlying infection.
- Informed consent should be obtained including a detailed explanation of the planned procedure, with procedure-specific risks and benefits—these include bleeding, infection, nerve damage, paresthesias, and dural puncture headache. Patients should be reassured that additional sedation and anesthesia can be given during the operation and that general anesthesia is an option if the block fails or the operation becomes more prolonged or extensive than originally thought; therefore, general anesthesia must also be on the consent form. In some instances, it is planned from the onset to have a combination of regional and general anesthesia.
- Monitoring: As with general anesthesia, patients should receive appropriate monitoring (see Chapter 15) and have an intravenous (IV) line in place. Oxygen, equipment for intubation and positive-pressure ventilation, and drugs to provide hemodynamic support must be available.