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Practical procedures, regional anaesthesia, and pain management in vascular surgery 

Practical procedures, regional anaesthesia, and pain management in vascular surgery
Chapter:
Practical procedures, regional anaesthesia, and pain management in vascular surgery
Author(s):

Dr Jonathan P. Thompson

, Dr Simon J. Howell

, and Dr Richard J. Telford

DOI:
10.1093/med/9780199594429.003.0006
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date: 14 October 2019

Many practical procedures may be required to manage the patient undergoing vascular surgery, and the vascular anaesthetist must be expert in all of these. This chapter describes all the major procedures needed for invasive monitoring, regional anaesthesia and pain management in the vascular patient in sufficient detail for the trainee or the more experienced anaesthetist in daily practice. It has been written by senior vascular anaesthetists and incorporates a whole range of procedures ranging from arterial and central venous catheterisation to lung isolation techniques and one-lung ventilation. Each section includes the indications, contra-indications and a description of the technique. Tips for success, based on the authors’ considerable experience, are included. A separate section is dedicated to the different methods of perioperative cardiac output monitoring currently available. More specialised techniques for spinal cord drainage and CSF and intra-abdominal pressure monitoring after major vascular surgery are also included. The section on specific regional anaesthetic block covers all the major plexus and nerve blocks commonly used for vascular surgical patients. These include detailed descriptions of cervical plexus blocks, the various approaches to brachial plexus blocks, lumbar plexus blocks and techniques for femoral, sciatic and popliteal nerve blockade. Each of these incorporates both landmark and ultrasound-guided techniques.. The estimated risks of neuroaxial blockade are included to help discussions with patients. The chapter includes recommended regimens for the treatment of acute pain using regional and systemic analgesia, the prevention of chronic pain associated with vascular surgery, including phantom limb pain.

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