Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Stellate ganglion block

Key Points Used for treatment or diagnosis of complex regional pain syndromes as well as upper limb vascular syndromes. Ultrasound appears to allow a more effective and precise sympathetic block. Long-lasting local anesthetics with steroid are commonly used. C7 transverse process and longus colli muscle must be located with a high-frequency linear transducer (6-13 MHz). The needle should be directed in-plane from lateral to medial towards…

Retrobulbar (peribulbar) block

KEY POINTS The most common complication of the retrobulbar block is hematoma formation, which can be minimized by using a needle shorter than 31 mm or performing a peribulbar approach. Sudden apnea may happen secondary to unexpected spinal anesthesia—related to injection within the optic nerve sheath. Additional block of the facial nerve is essential to produce an immobile eye by blocking the orbicularis oculi muscle. Perspective…

Ankle block

Perspective This block is often used for surgical procedures carried out on the foot, especially for those not requiring high lower-leg tourniquet pressure. Patient Selection. The ankle block is principally an infiltration block and does not require elicitation of paresthesia. Thus patient cooperation is not mandatory. Although the block is most efficient for the anesthesiologist if the patient can assume both the prone and supine positions,…

Popliteal and saphenous block

Perspective The nerves blocked in the popliteal fossa—the tibial and peroneal nerves—are extensions of the sciatic nerve. The principal use of this block is for foot and ankle surgery. The addition of a saphenous nerve block improves comfort, because medial lower leg and ankle sensory blockade makes tourniquets and medial ankle surgery more comfortable. Patient Selection. To use the classic form of this block, the patient…

Obturator block

Key Points The success of the block depends on the appropriate spread of local anesthetics in the appropriate fascial planes superficially and deeply to the adductor brevis muscle. Care should be taken to confirm the spread in the intermuscular fascial planes and not intramuscular. Change in adductor strength is the best assessment method for the block since the sensory distribution is variable. With a successful block,…

Ultrasound for fascia iliaca and inguinal region blocks

Key Points A high-frequency linear transducer is preferred for this block. The fascia iliaca compartmental block (FICB) can be used as an alternative anterior approach to the lumbar plexus block, targeting the femoral, obturator, and lateral femoral cutaneous nerves. The suprainguinal approach to the FICB is associated with better cranial spread of local anesthetic and more complete sensory blockade of the anterior, medial, and lateral thigh…

Femoral block

Perspective This block is useful for surgical procedures carried out on the anterior thigh, both superficial and deep. It is most frequently combined with other lower extremity peripheral blocks to provide anesthesia for operations on the lower leg and foot. As an analgesic technique, it is used for femoral fracture analgesia or for prolonged continuous catheter analgesia after surgery on the knee or femur. Patient Selection.…

Sciatic block

Perspective The sciatic nerve is one of the largest nerve trunks in the body, yet few surgical procedures can be performed with sciatic block alone. It is combined most often with femoral, lateral femoral cutaneous, or an obturator nerve block. The block is also effective for analgesia of the lower leg and may provide pain relief from ankle fractures or tibial fractures before operative intervention. Patient…

Lumbar plexus block

Inguinal perivascular block (three-in-one block) Perspective The inguinal perivascular block is based on the concept of injecting local anesthetic near the femoral nerve in an amount sufficient to track proximally along fascial planes to anesthetize the lumbar plexus. The three principal nerves of the lumbar plexus pass from the pelvis anteriorly: the lateral femoral cutaneous, the femoral, and the obturator nerves. As illustrated in Fig. 13.1…

Intravenous regional block

Key points Intravenous (IV) regional anesthesia is usually achieved using dilute lidocaine 0.5%; 50 mL of prilocaine has also been used successfully. The IV regional block is useful for procedures lasting 90–120 minutes. This time limit is due to tourniquet time constraints rather than to diminution of the local anesthetic effect. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited…

Distal upper extremity blocks

Key points Blockade of peripheral nerves of the upper extremity is often accomplished by brachial plexus approaches. However, conditions such as infections to brachial plexus sites, coagulopathy, single nerve distribution, minor procedures (not requiring a tourniquet), and rescue supplementations of brachial plexus block may require individual nerve blockade. Distal peripheral nerve blocks are associated with a slightly higher likelihood of nerve injury, possibly because of the…

Axillary block

Perspective Axillary brachial plexus block is most effective for surgical procedures distal to the elbow. Some patients can undergo procedures on the elbow or lower humerus with an axillary technique, but strong consideration should be given to a supraclavicular block for those requiring more proximal procedures. It is discouraging to carry out a “successful” axillary block only to find that the surgical procedure extends outside the…

Infraclavicular block

Perspective Infraclavicular brachial plexus block is useful for both single-injection and continuous infusion techniques. This technique results in a sensory and motor block similar to a traditional axillary approach, albeit with certain advantages. Thus it is most useful for patients undergoing procedures on the elbow, forearm, or hand. Like the axillary block, this technique is carried out distant from both the neuraxial structures and the lung,…

Suprascapular block

Key Points High-frequency, 38-mm broadband linear array transducer is preferred for this block. For catheter insertion, the Tuohy needle is usually used. The catheter is placed beneath the transverse scapular ligament around the suprascapular nerve (SSN). The correct position of the catheter can be confirmed under ultrasound by injecting either local anesthetic or 1 mL of air via the catheter and observing its distribution in relation…

Supraclavicular block

Perspective Supraclavicular block provides anesthesia of the entire upper extremity in the most consistent, efficient manner of any brachial plexus technique. It is the most effective block for all portions of the upper extremity and is carried out at the division level of the brachial plexus; perhaps this is why there is often little or no sparing of peripheral nerves if an adequate paresthesia is obtained.…

Interscalene block

Perspective Interscalene block (classic anterior approach) is especially effective for surgery of the shoulder or upper arm because the roots of the brachial plexus are most easily blocked with this technique. Frequently the ulnar nerve and its more peripheral distribution in the hand can be spared, unless one makes a special effort to inject local anesthetic caudad to the site of the initial paresthesia. This block…