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Nerve Blocks. Denise Ammon T4 Anesthesia 2/23/12. Brachial Plexus. Anatomy. Union of the anterior primary divisions of C5-8 and the T1 nerve. C4 and T2 may contribute as well. Roots  Trunks  Divisions  Cords  Terminal nerves (branches). “ Robert Taylor Drinks Cold Beer ”.

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nerve blocks

Nerve Blocks

Denise Ammon T4

Anesthesia

2/23/12

anatomy
Anatomy
  • Union of the anterior primary divisions of C5-8 and the T1 nerve.
    • C4 and T2 may contribute as well.
  • Roots  Trunks  Divisions  Cords  Terminal nerves (branches). “Robert Taylor Drinks Cold Beer”.
  • Terminal Branches: Axillary, Radial, Median, Musculocutaneous, and Ulnar. “ARM MU”.
interscalene block
Interscalene Block
  • Performed at the C6 level (cricoid cartilage level).
    • Ask patient to turn head to side.
    • Locate groove.
  • Between the anterior and middle scalene muscles.
    • The anterior scalene is an important landmark that should be identified.
      • Posterior to the posterior aspect of the SCM at the level of the cricoid.
      • Enter behind the External Jugular at 45 degrees caudad and posterior.
supraclavicular block
Supraclavicular Block
  • Needle enters 1.2cm above the middle of the clavicle.
  • Administer anesthetic while advancing needle towards the first rib.
    • Anterior-posterior direction until parasthesias are elicited.
sciatic nerve block
Sciatic Nerve Block
  • L4-5 and S1-3
    • Runs between the ischial spine and greater trochanter of the femur.
    • Becomes superficial at the base of the gluteus maximus.
  • Cutaneous innervation to posterior thigh and all of the leg below the knee minus a small medial strip.
  • Two approaches: Posterior and Anterior.
  • Usually block is combined with femoral, obturator, or lateral fem cutaneous nerve blocks.
  • Disadvantages: technically difficult, painful, possible hematoma, nerve damage, slight drop in BP due to blood pooling.
posterior approach
Posterior Approach
  • Lateral decub position with leg to be blocked flexed at the knee with the heel resting on the opposite knee.
  • Connect the posterior superior iliac spine with the greater trochanter with a drawing pen. Bisect this line perpendicularly, extending caudal.
  • Needle entry point: 3cm downward from the perpendicular line.
anterior approach
Anterior Approach
  • Supine position.
  • Line from ASIS to pubic tubercle. Mark point 2/3 of the way.
  • Draw parallel line from greater trochanter.
  • From point of first line, continue down to second line. Inject at this site until bone is hit, then direct medially.