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Excerpt
Case History 1: A 65 year old female presented with an abscess of her right wrist which required incision and drainage. Pre-operative bronchoscopy revealed an exophytic tumour occluding 90% of the left main bronchus. A brachial plexus block (axillary approach) provided satisfactory anaesthesia for her surgery.
Case History 2: An 85 year old male presented with a necrotic 3rd toe on his left foot for mid-tarsal amputation. Comorbidities included ischaemic cardiomyopathy and intercurrent congestive cardiac failure; his medications included clopidrogel. A sciatic nerve block supplemented by a saphenous nerve block provided surgical anaesthesia.
Case History 3: A 71 year old female presented with an intertrochanteric femoral fracture which required fixation with a dynamic hip screw. Co-morbidities included marked respiratory limitation (FEV1 0.8, room air SaO2 90%) and aortic stenosis (gradient assessed as 35mmHg 2 years previously). Anaesthesia was managed using direct arterial pressure monitoring, combined spinal epidural with low dose opioid-free technique.
Discussion: The most significant and consistently demonstrated advantage of regional anaesthesia techniques is the superior quality of postoperative analgesia afforded [1]. Claims that such techniques impact on morbidity or mortality remain controversial [2].However, regional techniques provide a useful alternative to general anaesthesia in a number of clinical situations as exemplified by the cases described. Anaesthesia training programmes need to emphasise the performance of regional techniques.
