title: Monitoring regional blockade.
abstract: This review attempts to draw on the published literature to address three practical clinical questions. First, what means of testing the degree of regional blockade pre-operatively are available, and can eventual success or failure be determined soon after injection? Second, is it possible to predict if a block inserted after the induction of general anaesthesia will be effective when the patient wakes? Third, what features, and what duration, should cause concern when a block does not resolve as expected after surgery? Although the relevant literature is limited, we recommend testing of multiple sensory modalities before surgery commences; temperature and thermographic changes may offer additional early warning of success or failure. There are a number of existing methods of assessing nociception under general anaesthesia, but none has yet been applied to gauge the onset of a regional block. Finally, criteria for further investigation and neurological referral when block symptoms persist postoperatively are presented.
authors.affiliation: Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK.
authors.forename: K
authors.initials: K
authors.lastname: Ode
authors.affiliation: Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK.
authors.forename: S
authors.initials: S
authors.lastname: Selvaraj
authors.affiliation: Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK.
authors.forename: A F
authors.initials: AF
authors.lastname: Smith
mesh_terms: D000768:Anesthesia, General; D006801:Humans; D008991:Monitoring, Physiologic; D009407:Nerve Block; D013514:Surgical Procedures, Operative; D013817:Thermography
keywords: nociception; regional anaesthesia; sensory testing; spinal anaesthesia