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Nerve Blocks

Nerve Blocks. Steven Lanski, MD Assistant Professor Pediatrics and Emergency Medicine Emory University. What is Pain?. What is Pain?. International Assoc for the Study of Pain: “an unpleasant sensory and emotional experience connected with actual or potential tissue damage…”

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Nerve Blocks

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  1. Nerve Blocks Steven Lanski, MD Assistant Professor Pediatrics and Emergency Medicine Emory University

  2. What is Pain?

  3. What is Pain? International Assoc for the Study of Pain:“an unpleasant sensory and emotional experience connected with actual or potential tissue damage…” • afferent impulses from averse stimuli • processing of that information

  4. Factors Involved • Thickness • Myelination • Perception

  5. Components of the Pain System: Sensation • Afferent fibers • “A” delta fibers: mechanoceptors(pressure) • small, lightly myelinated …”first” pain • rapid, sharp, localized • “C” fibers: polymodal(heat,chemical) • unmyelinated (slower)…”second” pain • delayed, prolonged, dull, poorly localized

  6. Mechanism of Action Decreases sodium influx across neuronal membranes Decreases polarization amplitude No action potential No impulse

  7. Duration of action Dependant upon protein binding and blood supply.

  8. Adverse Reactions • Cardiovascular - hypotension, bradycardia • CNS - excitatory - seizures • Allergic - preservative - methylparaben esters - tetracaine, benzocaine, procaine, cocaine amides - lidocaine, bupivacaine, diphenhydramine (1%) • Anxiety

  9. Facial Supraorbital and trochlear infraorbital mental ear dental Extremity digital radial median ulnar sural tibial Locations

  10. Supraorbital/Supratrochlear Blocks Helpful for multiple lacerations of forehead and anterior scalp

  11. Supraorbital/Supratrochlear Blocks Landmark - superior orbital rim

  12. Infraorbital Block Anesthesia to lower eyelid, lateral inferior nose and lower lip

  13. Infraorbital Block Landmarks - canine, infraorbital foramen

  14. Mental Nerve Block Anesthesia to lower lip and partial chin

  15. Mental Nerve Block Landmark - 2nd bicuspid

  16. Auricular Block

  17. Dental Blocks • Local • Inferior Alveolar - anesthesia to the mandible, teeth and chin

  18. Inferior Alveolar Block Landmarks - ramus of the mandible and coronoid notch

  19. Digital Blocks • Dorsal and palmar digital nerves • Toes (except 1st) single needle insertion

  20. Digital Blocks Landmarks - bone and web space

  21. Thumb Block

  22. Median Nerve Block • Anesthesia to palm (radial half), 1st-3rd digits • Landmark - proximal flexor crease, radial artery, flexor carpi radialis and palmaris longus tendons.

  23. Ulnar Nerve Block • Anesthesia to dorsal and palmar aspect of hand (ulnar half), ulnar half of 4th digit and 5th digit • Landmarks - flexor carpi ulnaris and ulnar artery - dorso-ulnar aspect wrist (2nd branch)

  24. Radial Nerve Block • Anesthesia to dorsal surface of 1st-3rd digits and radial portion of hand • Landmark – dorso-radial aspect of wrist

  25. Sural Nerve Block • Anesthesia to heel and lateral half of foot • Landmarks - lateral malleolus, Achilles tendon

  26. Posterior Tibial Block • Anesthesia to the medial aspect of the foot • Landmark - posterior tibial artery, Achilles tendon and medial malleolus

  27. Penile Block Landmarks - base of penis and Buck’s fascia

  28. Conclusion • Choice of agents based on duration required • Beneficial for multiple or extensive injuries in which conscious sedation will not be performed • More comfortable than local infiltration in some sites

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