Regional Nerve Block

OVERVIEW

Presented here is a commonly used mnemonic applicable as an approach to any regional nerve block.

CIMPLE-D

• Consent
  • Documented patient consent
  • Include discussion about LA toxicity symptoms and the need to notify any such symptoms to clinical staff
• IV Access
  • Secure this before any local anaesthetic is injected
• Monitoring
  • As per institution guidelines
  • Typical minimum is ongoing BP, resp rate, GCS
  • SPO2 and ECG are advisable
  • Monitoring should continue for minimum 30mins post-block, or until vital signs are stable
• Position / Preparation
  • Position
    • Consider optimal patient and operator positioning for specific block to be performed
  • Preparation
    • Sterile field
    • Allow antibacterial skin prep to dry
  • Block Time Out
    • Ensure correct patient, block site, review allergies, check equipment
• Local Anaesthetic
  • As per institution guidelines
  • Ropivacaine results in less overall motor block and has a higher safety margin (CC:CNS ratio is better) than bupivacaine
  • Lignocaine mixed in with longer acting local anaesthetic (eg: ropivacaine or bupivacaine) will result in faster onset of block
  • Calculate and avoid toxic local anaesthetic dose, especially for vessel rich areas
• Equipment / Endpoint
  • Equipment
    • USS with sterile probe cover
    • Needle designed for sonographic visualisation
    • Resus equipment
    • Know where your department’s IV lipid rescue (eg: Intralipid) is stored
  • Endpoint:
    • Assess block effect, be immediately available post-block for assistance (eg: if local anaesthetic toxicity develops)
• Document
  • Site of block
  • Local anaesthetic dose and time given
  • Complications if any
  • Post-block instructions
  • Plan for post-block review as per institution guidelines including referral to acute pain service if regional catheter placed

References

• Australian and New Zealand College of Anaesthetists [Internet].  PS-03 Guidelines for the management of major regional anaesthesia. Melbourne VIC: ANZCA; 2014. [cited 2021 Jan 15]. Available from: https://www.anzca.edu.au/resources/professional-documents/guidelines
• Peck TE, Hill SA. Pharmacology for Anaesthesia and Intensive Care. 4th Ed. Cambridge University Press. 2014.

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