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.

CCC 700 6

Critical Care

Compendium

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