Intermittent Boluses and Continuous Infusions of Local Anaesthetics for Acute Pain Management in Adults

Introduction

This document offers guidance to the use of peripheral and nerve plexus local anaesthetic blocks requiring either a bolus dose and/or infusion technique via a catheter. The policy excludes the management of epidural or spinal centro-axial blocks which is covered in other guidance. This guidance is aimed (but not exclusively) at the following peripheral nerve blocks:

• Group 1: Facial Plane blocks - Rectus sheath, Transversus abdominis Plane (TAP), Erector Spinae, Pectoral, Quadratus Lumborum, Facia Iliacus and Subcostal TAP blocks
• Group 2: Peri-neurial blocks - Brachial Plexus (Interscalene, Supraclavicular, Infraclavicular, axillary), isolated nerve blocks of the forearm, femoral nerve block, sciatic nerve block.
• Group 3: Paravertebral blocks

Purpose

• To ensure a common safe standardised regime regarding local anaesthetic is used by all health professionals involved in the care of patients at SPH.
• To ensure staff knowledge and competencies throughout the Trust regarding local anaesthetic drug administration, indications for use and side effects/complications management are up to date. Additionally there needs to be robust knowledge and support for managing the infusion pumps.
• To ensure that appropriate training in line with Trust policies is undertaken by those using the equipment or delivering bolus injections.

Policy Details

See also:

• Protocol for post-operative observation in adult inpatient areas and local anaesthetic observations chart
• Competency for the injection of local anaesthetic into a fascia iliaca block catheter
• Medicines Management Policy