Administration of Regional Anesthesia by Certified Registered Nurse Anesthetists

Formerly Position Statement Number 2.6

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Regional anesthesia is an accepted anesthetic technique that has gained increasing popularity in recent years as operative procedures have become less invasive, technology has improved, and care has transitioned from the hospital setting to ambulatory and office-based settings.  Regional anesthesia techniques may include, but are not limited to, spinal, epidural, peripheral nerve blocks, upper and lower extremity blocks, airway blocks, and pain management. These techniques may be used for anesthesia and analgesia for a variety of surgical, obstetrical, diagnostic and therapeutic procedures either alone or in combination with a general anesthetic. Studies demonstrate that regional anesthesia has many benefits for patients receiving these techniques.  For example, regional anesthesia has been associated with decreased morbidity, decreased postoperative complications, a reduction in the stress response due to surgery and anesthesia, and increased patient satisfaction.1-7 Most recently, it has been shown that regional anesthesia may positively impact long-term healing and immune function.2,4,6
 
Innovations in regional anesthesia technology have resulted in improved patient outcomes and better quality blocks.6,8,9 Peripheral nerve stimulators, as well as image-guided technology such as ultrasound and fluoroscopy, have been shown to improve regional anesthesia safety and accuracy.6,9-14 These advancements have the potential to minimize regional anesthetic-related complications. As technology and devices change, it is the CRNA’s responsibility to understand how each of these technologies and devices operates to ensure patient safety.
 
Regional anesthesia techniques and the technology used to administer a given technique, fall well within the professional scope of practice for CRNAs. Through education and individual clinical experience, CRNAs obtain the ability to initiate and manage all regional anesthesia techniques as well as any associated complications.  The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) specifies the requisite number of spinal, epidural and peripheral nerve blocks that must be completed during a nurse anesthesia program in order for a graduate to be eligible to sit for the national certification exam (NCE). As professionals, CRNAs continually engage in life-long learning and seek to ensure the provision of safe and competent anesthesia care, including regional anesthesia.
 
References
  1. Barash PG, Cullen BF, Stoelting RK, Cahalan M, Stock MC. Clinical Anesthesia. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009.
  2. Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. Oct 2006;105(4):660-664.
  3. Broking K, Waurick R. How to teach regional anesthesia. Curr Opin Anaesthesiol. Oct 2006;19(5):526-530.
  4. Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology. Aug 2008;109(2):180-187.
  5. Viscusi ER. Patient-controlled drug delivery for acute postoperative pain management: a review of current and emerging technologies. Reg Anesth Pain Med. Mar-Apr 2008;33(2):146-158.
  6. Hadzic A, Vloka JD. Peripheral nerve blocks: principles and practice. New York, NY: McGraw-Hill; 2004.
  7. Grossi P, Urmey WF. Peripheral nerve blocks for anaesthesia and postoperative analgesia. Curr Opin Anaesthesiol. Oct 2003;16(5):493-501.
  8. Mordecai MM, Brull SJ. Spinal anesthesia. Curr Opin Anaesthesiol. Oct 2005;18(5):527-533.
  9. Faut-Callahan M, Hand Jr WR. Pain management. In: Nagelhout JJ, Plaus KL eds. Nurse Anesthesia. 4th ed. St. Louis, MO: Saunders; 2010:1239-1267.
  10. Chin KJ, Chan V. Ultrasound-guided peripheral nerve blockade. Curr Opin Anaesthesiol. Oct 2008;21(5):624-631.
  11. Buckenmaier C. Military advanced regional anesthesia and analgesia handbook.  Washington, DC: Borden Institute; 2009.
  12. Chan VW, Perlas A, McCartney CJ, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. Mar 2007;54(3):176-182.
  13. Mordecai MM, Brull SJ. Spinal anesthesia. Curr Opin Anaesthesiol. Oct 2005;18(5):527-533.
  14. Huntoon MA. Ultrasound in pain medicine: advanced weaponry or just a fad? Reg Anesth Pain Med. Sep-Oct 2009;34(5):387-388.

 


Adopted by the Council on Nurse Anesthesia Practice May 1978.
Adopted by AANA Board of Directors February 1989.
Revised by AANA Board of Directors August 2000, August 2007, and August 2010.