PreEmpt Pain App. Exercise 4.
Regional Anesthesia / Local Anesthesia
An integral aspect of a pain management plan is consideration of all strategies to treat pain and minimize use of systemic medications. While not all patients and conditions can benefit from formal regional anesthesia techniques, the simpler use of local anesthetics can still have great impact on improving patient comfort, mobility, respiratory mechanics, and minimizing postoperative pain.
The Regional Anesthesia / Local Anesthesia page of the PreEmpt Pain app prompts you to consider what regional or local anesthesia techniques may have been administered for your patients with acute pain. All medical records are different but often this information can be found within the Anesthesia Record, if regional anesthesia was performed, or the Operative Note if local anesthesia as infiltration was administered.
Being aware of the techniques used will guide your decisions of medications to consider in the post-operative period. On some occasions these techniques may preclude subsequent use of local anesthetics.
The first point to consider is whether a regional anesthetic technique /local anesthetic was administered ( Yes / No / Unsure). To help you identify the various types of these techniques, examples are given. Local anesthetics vary in their delivery systems and all of these must be considered, including 'mouthwash' products with lidocaine or other local anesthetics (for mucositis) topical products.
If you have previously completed the initial Demographics screen for your patient, the 'Surgery / condition Date' should be automatically populated. You can complete it on this page if you have not already done so. The 'RA Date' will usually be the same as the procedure but keep in mind this is not true in all cases.
This icon will allow you to reset the date if needed.
Next, the Route of administration needs to be considered; sometimes there is more than one type of regional / local anesthetic administered. Be sure to include all of them.
Finally, the type of local anesthetic / adjunctive medication that was administered is important as the agents may have different durations of action. The possibility for local anesthetic toxicity needs to be considered and might preclude use of additional local anesthetics in the post-operative period. For example, the administration of liposomal bupivacaine necessitates avoidance of other local anesthetic techniques for the following 96 hours unless there is an extenuating circumstance. Check with your institution for the policy.
Once the RA / LA screen is completed, it will populate the Comprehensive Pain Plan for your review. Be sure to include this information when completing a sign off to a colleague. It is quite common for these regional anesthesia and local anesthesia techniques to be overlooked when developing a comprehensive pain management plan. If you take the time to learn where these procedures are documented in your institution's electronic medical record and consider them in the development of your plan, you will be better prepared to thoroughly know your patient and provide optimal pain care.
Do you know where to find the regional anesthesia information in your institution's electronic medical record? Have you wanted to have a better understanding of the regional anesthesia techniques used for your patients? If so, check out an upcoming post of mine for a more thorough explanation of the techniques that anesthesiologists and surgeons administer as part of pre-emptive analgesia in the operating room.
Drop a comment about this post or provide your own tips about regional anesthesia techniques in your practice.