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Recommended practices for managing the patient receiving local anesthesia

The following recommended practices were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were presented as proposed recommended practices for comments by members and others. They are effective Jan 1, 2002.

These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the recommended practices can be implemented.

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AORN recognizes the various settings in which perioperative nurses practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization laboratories, endoscopy suites, radiology departments, and all other areas where operative and other invasive procedures may be performed.

Purpose: These recommended practices provide guidelines for RNs managing patients receiving local infiltration anesthesia only. If any sedation is used, AORN's "Recommended practices for managing the patient receiving moderate sedation/analgesia" should be followed. It is not the intent of these recommended practices to address situations that require the services of anesthesia care providers or to substitute RN services in those situations that require the services of anesthesia care providers, regardless of the complexity of the surgical procedure.

RECOMMENDED PRACTICE I

Patients receiving local anesthesia during a surgical procedure should be assessed throughout the perioperative experience by an RN.

1. The selection of patients who are to receive local anesthesia should be determined by established criteria developed through an interdisciplinary collaboration of health care professionals.

2. Many healthy patients undergo minor surgical procedures that require only small doses of local anesthetic medications. These patients are at low risk for anesthetic complications and require minimal observation and intervention.

3. The decision to monitor, the parameters monitored, and the frequency of observation should be tailored to the patient and the surgical procedure. (1) If/when administering medications, the perioperative nurse must work within his or her scope of practice.

4. Local anesthesia is not practical for all patients or all types of surgical procedures. (2) Highly nervous, apprehensive, or excitable patients or those who are unable to cooperate because of their mental state or age may not be good candidates for local anesthesia. (3) Each patient has a variety of unique physical characteristics that can influence his or her response to medications. Considerations include, but are not limited to, the patient's weight, age, and medication tolerance and the presence of disease. (4)

5. In the preoperative phase, the RN should review the patient's history, physical examination findings, laboratory results, and other diagnostic test results if indicated. During this preoperative assessment, the perioperative nurse should determine, at a minimum,

* the patient's allergies and sensitivities (eg, medications, tape, latex, prep solutions);

* the patient's age, current medications, alternative/complementary therapies, and emotional status;

* when the patient last consumed solids and/or liquids by mouth (ie, NPO status);

* whether the surgical site can be anesthetized completely with a local injection; and

* pulse, blood pressure, arterial oxygen percent saturation, skin status, mental status, and pain management status. (5)

The need for IV access and/or fluids should be based on patient assessment data and facility policy.

6. The RN should develop a plan of care to include potential problems and stress responses to local anesthesia. Surgery may elicit physiological (eg, autonomic disturbances that may cause fainting) and psychological (eg, fear of the unknown that may cause anxiety) responses in the patient. The degree of combined stressful stimuli directly determines the response of the patient. (6)

7. The RN should ensure the availability of emergency equipment and be prepared to intervene should an adverse reaction occur. Serious cardiac or respiratory complications can occur abruptly after the administration of local anesthetic medications. If the medication enters the bloodstream directly, convulsions, circulatory and respiratory distress, cardiovascular collapse, or even death can result. (7) Emergency medications, suction apparatus, resuscitative equipment, and qualified personnel should be readily available. (8) At a minimum, personnel should be competent in cardiopulmonary resuscitation.

RECOMMENDED PRACTICE II

The RN managing the nursing care of the patient receiving local anesthesia should monitor the patient's physiological and psychosocial status throughout the procedure.

1. At a minimum, the perioperative RN should monitor the patient's heart rate and regularity, respiratory rate, and mental status throughout the procedure. Other monitoring parameters include, but are not limited to, (9)

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Recommended practices for managing the patient receiving local anesthesia

AORN Journal, April, 2002

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