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Nursing Care for Local Anesthesia

The patient, a 32-year-old male athlete, underwent hernia repair surgery using spinal anesthesia with bupivacaine, a long-acting local anesthetic. Two hours after the procedure, the patient appeared agitated and still had limited movement and no feeling in his legs. The nurse should monitor the patient's vital signs closely as the long-acting anesthetic could still be affecting him. Bupivacaine has an onset of 5-20 minutes and duration of 2-7 hours. The nurse should reassure the patient that the effects are temporary and assess his anxiety level given his occupation as an athlete.

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Sittie Hidaya Mai
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22 views4 pages

Nursing Care for Local Anesthesia

The patient, a 32-year-old male athlete, underwent hernia repair surgery using spinal anesthesia with bupivacaine, a long-acting local anesthetic. Two hours after the procedure, the patient appeared agitated and still had limited movement and no feeling in his legs. The nurse should monitor the patient's vital signs closely as the long-acting anesthetic could still be affecting him. Bupivacaine has an onset of 5-20 minutes and duration of 2-7 hours. The nurse should reassure the patient that the effects are temporary and assess his anxiety level given his occupation as an athlete.

Uploaded by

Sittie Hidaya Mai
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd

Name: MACAPAAR, Sittie Alliana M.

Date: December 1, 2022


Section: Ww
CRITICAL THINKING

THE SITUATION

A.M., a 32-year-old male athlete with a history of asthma (which could indicate pulmonary
dysfunction), was admitted to the hospital for an inguinal hernia repair. At the patient’s
request, the surgeon elected to use a local anesthetic employing spinal anesthesia. Because
the extent of the repair was unknown (A.M. had undergone two previous repairs),
bupivacaine, a long-acting anesthetic, was selected. He remained alert (blood pressure
120/64 mm Hg, pulse 62 beats/min, respiration rate 10/min) and stable throughout the
procedure. Two hours after the conclusion of the proce dure, A.M. appeared agitated (blood
pressure 154/68 mm Hg, pulse 88 beats/min, respiration rate 12/min). Although he did not
complain of discomfort, he did state that he still had no feeling and had only limited
movement of his legs.

What safety precautions need to be taken?


➢ Before proceeding to the procedure, the patient should already instructed to refrain from
eating during the few hours before surgery and should not drink alcohol for 24 hours before
the procedure to prevent bleeding during the operation. Also, ensure that patient should
feel the numbing effect before proceeding to the procedure to prevent them from
experiencing pain during the procedure. And, if patient felt the numbing effect, advise him
to careful not to injure themselves while they cannot feel pain. Moreover, often place a
small device (pulse oximeter) on the person’s finger so that it can monitor the amount of
oxygen in the blood.

What nursing interventions should be done at this point?


➢ Since the patient had undergone two previous repairs, bupivacaine, a long-acting anesthetic,
was administered to him therefore he won't be able to feel any pain but he may still feel
some pressure or movement. So, it is important to monitor the patient and be carefully
watched as the medicines used for anesthesia affect the central nervous system which it
may suppresses many of the body's normal automatic functions. Also, to monitor the vital
signs of the patient to see and observe if there is any abnormal changes because the patient
won’t be able to complain as he doesn’t feel any pain and numb. Moreover, it is important
also to observe the physical health to sudden changes to prevent injury during the time that
the patient has a loss of sensation and/or mobility.

How could the patient be reassured? Think about the anxiety level of the patient—an athlete
who elected to have local anesthesia may have a problem with control and feel somewhat
invincible. Consider the anxiety that loss of mobility and sensation in the legs may cause in a
person who makes his living as an athlete.

➢ Usually, patients are concern about the anticipated anesthetic complications, surgical
techniques, success of operation, fear of being unconscious, pain and weakness in any part
of the body postoperatively, and sometime even death, which increases the anxiety. As a
healthcare provider, it is my responsibility to provide care to the patient and assure that all
of the procedures are safe and it is for his recovery just like how he survive the two previous
repairs. Knowing that he is an athlete, it is given that he may feel anxious because local
anesthesia causes loss of sensation on certain parts of the body and loss mobility but I will
let him know that the effect of that medication will just subside and will not obliterate his
sensation forever. I will inform him about the onset and duration of its effect to allay his
anxiousness.

In addition, consider the expected duration of action of bupivacaine and the rate of return
of function.
➢ Bupivacaine has a significantly longer duration of action and slower time to onset.
Bupivacaine has an onset of 5 min to 20 min, a duration of 2 h to 7 h and maximum dose
of 2 mg/kg.

NURSING CARE GUIDE: Local Anesthesia


➢ Local anesthesia refers to a loss of sensation in limited areas of the body. Local anesthesia
can be achieved by several different methods: topical administration, infiltration, field
block, nerve block, and intravenous regional anesthesia. It involves numbing an area of the
body using a type of medicine called a local anaesthetic. These medicines can be used to
treat painful conditions, prevent pain during a procedure or operation, or relieve pain after
surgery. It does not cause a loss of consciousness before a medical procedure. People who
get a local anesthetic are still awake for the procedure but cannot feel the area of the body
being treated.

Assessment: History and Examination


These are the important things the nurse should include in conducting assessment, history taking,
and examination:
➢ Assess for contraindications and cautions: any known allergies to these drugs or to
parabens to avoid hypersensitivity reactions; impaired liver function, which could alter
metabolism and clearance of the drug; low plasma esterases, which could lead to toxicity
of esters; heart block, which could be exacerbated by the drug effects; shock to prevent
altered local delivery and absorption; and current status of pregnancy or lactation, which
are cautions to the use of the drug.
➢ Perform a physical assessment to establish a baseline status before beginning therapy and
for any potential adverse effects.
➢ Inspect site for local anesthetic application to ensure integrity of the skin and to prevent
inadvertent systemic absorption of the drug.
➢ Assess the patient’s neurological status, including level of orientation, reflexes, pupil size
and reaction, muscle tone and response, and sensation, to evaluate the effectiveness of the
drug and monitor for potential toxic neurological effects.
➢ Monitor vital signs, including temperature, pulse, and blood pressure, and assess
respiratory rate and auscultate lungs, for adventitious sounds to identify changes and
possible systemic absorption.
➢ Monitor laboratory test results, such as liver function tests and plasma esterases (if
appropriate), to determine possible need for dose adjustment.
➢ Refer to the Critical Thinking Scenario for a full discussion of nursing care for a patient
who is receiving local anesthesia.

Nursing Diagnoses
Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:
➢ Disturbed Sensory Perception (Kinesthetic, Tactile) related to local anesthetic effect
➢ Impaired Skin Integrity related to immobility caused by actions of the drug
➢ Risk for Injury related to loss of sensation and mobility
➢ Deficient Knowledge regarding drug therapy

Implementation
These are vital nursing interventions done in patients who are taking local anesthetics:
➢ Have emergency equipment readily available to maintain airway and provide mechanical
ventilation if needed.
➢ Ensure that drugs for managing hypotension, cardiac arrest, and central nervous system
(CNS) alterations are readily available in case of severe reaction and toxicity.
➢ Ensure that patients receiving spinal anesthesia or epidural anesthesia are well hydrated
and remain lying down for up to 12 hours after the anesthesia to minimize headache.
➢ Establish safety precautions to prevent injury during the time that the patient has a loss of
sensation and/or mobility.
➢ Provide meticulous skin care to the site of administration to reduce the risk of breakdown.
➢ Provide comfort measures to help the patient tolerate drug effects. Provide pain relief, as
well as skin care and turning to prevent skin breakdown, and supportive care for
hypotension to prevent shock or serious hypoxia.
➢ Offer support and encouragement to help the patient cope with the procedure and drugs
being used.
➢ Provide thorough patient teaching, including anesthetic to be given, method for
administration, activities involved with administering and monitoring the drug, and safety
precautions.

Evaluation
Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:
➢ Monitor patient response to the drug (loss of feeling in designated area).
➢ Monitor for adverse effects (respiratory depression, blood pressure changes, arrhythmias,
gastrointestinal upset, skin breakdown, injury, CNS alterations).
➢ Evaluate the effectiveness of the teaching plan (the patient can relate the anticipated effects
of the drug and the recovery process)
➢ Monitor patient compliance to drug therapy.

Patient teaching
➢ Instruct the patient to refrain from eating during the few hours before surgery.
➢ Inform the patient not to drink any alcohol for 24 hours before receiving the anesthetic.
➢ Inform the patient and/or SO that local anesthesia may cause temporary loss of sensation
or motor activity.
➢ Encourage patient to communicate with his loved ones or friends for him not to feel sad
and allay anxiousness.
➢ Instruct patient to notify healthcare professionals if he feels other health problems.

Common questions

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Key nursing interventions include continual monitoring of vital signs to detect changes indicative of systemic absorption or neurological effects, providing reassurance and explaining that sensation will return as the anesthetic wears off, and ensuring safety to prevent injury due to numbness and mobility loss . Ensuring the patient remains hydrated and lies down can minimize potential headaches associated with spinal anesthesia .

Healthcare providers can support psychological well-being by actively communicating with the patient about their recovery status and expected timelines for sensation return . Offering comfort measures, emotional support, and reassurance about the temporary nature of numbness can help ease anxiety. Encouraging patient expression of concerns and active listening provides psychological comfort, while involving family members enhances emotional support .

A critical nursing assessment includes checking for contraindications such as drug allergies, impaired liver function, altered metabolism, or cardiac issues that could be exacerbated by the anesthetic . A thorough physical assessment to establish baseline vitals and neurological status, including reflexes and sensation, is essential to monitor safety and drug effectiveness .

To reassure an anxious patient, healthcare providers should explain the temporary nature of the anesthesia's effects and the duration they should expect them to last, emphasizing that normal sensation and mobility will return . Providing details about their medical procedure's safety and encouraging communication with loved ones can also help reduce anxiety . Explaining the routine nature of their procedure helps normalize the experience .

Monitoring cognitive and physical health involves assessing the patient's neurological status, including their level of orientation, reflex functionality, and sensation to evaluate effectiveness and detect potential toxic neurological effects . Regular assessment of muscle tone and response provides insight into potential drug-induced complications. Continuous vital sign monitoring helps identify systemic absorption issues .

Teaching strategies include one-on-one educational sessions during preoperative visits, where instructions are clearly explained regarding fasting and alcohol avoidance . Utilizing written materials and visual aids can reinforce verbal instructions. Confirming understanding through teach-back methods ensures instructions are understood. Additionally, involving family members in education sessions can provide further support and reinforce key information .

Safety precautions for a patient undergoing spinal anesthesia with bupivacaine include instructing the patient to refrain from eating a few hours before surgery and avoiding alcohol 24 hours prior to the procedure to prevent bleeding and interference with anesthesia. Additionally, the patient should feel the numbing effect before proceeding to prevent pain during the procedure . Monitoring the patient's oxygen levels with a pulse oximeter is also crucial to detect hypoxia early . These precautions help mitigate complications like aspiration due to incomplete fasting, and injury from unrecognized pain due to numbness .

Nurses should have emergency equipment available to maintain airway and provide mechanical ventilation if needed. Drugs for managing hypotension, cardiac arrest, and CNS alterations should be readily accessible in case of severe reaction or toxicity . Monitoring vital signs and having detailed patient assessment ensure readiness for any potential adverse reactions such as respiratory depression and arrhythmias .

Bupivacaine's long duration of effect (2 to 7 hours) and slower onset (5 to 20 minutes) require careful monitoring to manage the patient's recovery process effectively . Nursing interventions should include monitoring for prolonged numbness and immobility, evaluating the return of function, and addressing any complications that may arise from the extended action of the drug, such as circulatory or neurological alterations .

To ensure patient safety, it is critical to place the patient in a position to reduce pressure and prevent injury from numb areas . Continuous monitoring of vital signs is crucial to detect any adverse reactions. Providing clear instructions to the patient and family about potential side effects, and when to seek help, aids in preventing complications . Ensuring hydration and monitored rest post-procedure helps minimize headaches and accelerates recovery .

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