Regional anaesthesia for orthopaedic procedures

Regional anaesthesia is apposite for orthopaedic surgery for anatomical reasons and to reduce complications from general anaesthesia. A reduction in pain scores, drowsiness and nausea can improve postoperative mobility and facilitate earlier hospital discharge. Disadvantages include block failure, nerve injury, possible loss of motor function and proprioception and local anaesthetic toxicity. Complications are rare but may be reduced by the use of ultrasound and nerve stimulation, performing the block on a conscious patient and stopping injection if there is pain or high resistance. Patients should be assessed preoperatively to rule out contraindications such as local infection or coagulopathy, and clear explanations of the procedure and any possible complications should be given. Patients should also be assessed postoperatively and any suspicious findings investigated promptly and followed up until there is complete resolution.