Aust Fam Physician
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The effective and safe use of brachial plexus block anaesthesia requires the careful practice of a simple technique, a healthy regard for its potential general and local complications, and due consideration for the patient's psychological comfort. Providing combined anaesthesia and motor block and a variable period of postoperative analgesia, it is the preferred anaesthetic for many forms of hand surgery. Further, it is a valuable alternative for most of the surgery of the upper limb in patients in whom general anaesthesia is particularly hazardous.
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An understanding of the physiological changes seen in late pregnancy, avoidance of the supine posture, together with routine administration of alkali during labour and a careful anaesthetic technique will enable the anaesthetist to avoid many of the potential problems of obstetric anaesthesia.
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The epidural must be regarded as a technique which requires a high level of understanding, and it should be used only by people who have received adequate training. When a spinal technique is thought to be preferable to general anaesthesia for surgical operations, the majority of cases would be managed more certainly and in greater safety by the subarachnoid technique. In obstetrics, the use of the epidural for relieving the pain of first stage labour, though excellent in experienced hands, is the situation above all others requiring great understanding on the part of doctors and nurses alike. The epidural (usually caudal) technique is the ideal method of analgesia for forceps delivery, but in view of the possibility of its associated side effects and complications arising while the operator is occupied with the obstetrical problem, the analgesia and the obstetrics should be managed by separate individuals.