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Regional Nerve Blocks. Josh Major Anesthesia Clerkship. History of Peripheral Nerve Block. 1880’s: William Stewart Halstad and Richard John Hall describe injecting cocaine into peripheral sites during minor surgery 1914: Heinrich Braun describes techniques for every region of the body.

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regional nerve blocks

Regional Nerve Blocks

Josh Major

Anesthesia Clerkship

history of peripheral nerve block
History of Peripheral Nerve Block
  • 1880’s: William Stewart Halstad and Richard John Hall describe injecting cocaine into peripheral sites during minor surgery
  • 1914: Heinrich Braun describes techniques for every region of the body.
  • 1922: Regional Anesthesia: It’s Technic and clinical Application written by Gaston Labot at the Mayo Clinic
    • Definitive regional anesthesia textbook for 30 years.
indications for regional nerve block
Indications for Regional Nerve Block
  • Pain control post-op associated with surgical procedures
    • Improved patient satisfaction due to decreased pain, opioid use and side effects and decreased incidence of sleep disturbance
  • Useful in patients in whom general anesthesia is contraindicated or prevent undesired effects
contraindications
Contraindications
  • Absolute Contraindications:
    • Infection at site of block
    • Patient refusal
    • Allergy to local anesthetic
  • Relative Contraindications:
    • Medical anticoagulation or coagulopathy in deeper nerve blocks
types of nerve blocks
Types of Nerve Blocks
  • Single Shot: one time injection of local anesthetic to target nerve
  • Continuous Perineural Blockade: percutaneous insertion of a catheter directly adjacent to target nerves
upper extremity blocks1
Upper Extremity Blocks
  • Interscalene Block – Indication: Surgery or manipulation of the shoulder
  • Supraclavicular Block – Indication: Elbow, forearm and hand surgery
  • Infraclavicular Block – Indication: Provide anesthesia to the arm and hand
  • Axillary Block – Forearm and hand surgery
lower extremity blocks1
Lower Extremity Blocks
  • Femoral Nerve Block – Indication: Knee arthroscopy, femoral shaft fractures, total knee repair and ACL reconstruction
  • Obturator Nerve Block – Indication: Knee surgery, rarely blocked on it’s own
  • Sciatic Nerve Block – Indication: Can be used together with a femoral or saphenous block for any procedure below the knee that doesn’t need a thigh tourniquet
choices of local anesthetic
Choices of Local Anesthetic
  • Depends primarily on required duration of anesthesia
  • Different anesthetic drugs have varying durations
  • Blockade may last up to 24 hours
  • Epinephrine can be added to improve onset of action and prolong drug action
major nerve block drugs
Major Nerve Block Drugs

Major Nerve Blocks

ultrasound guidance
Ultrasound Guidance
  • Allows direct visualization of the nerve, needle, and anesthetic distribution
  • Commonly used as an adjunct to regional anesthesia techniques
  • Can be useful in decreasing complications
  • Facilitates placement of blocks in patients with challenging anatomy
complications
Complications
  • Block Failure
  • Perineural Hematoma
  • Infection
  • Nerve Injury
  • Intravascular Injection
  • Intraneural Injection
  • Excessively Dense Block
references
References
  • Miller, M.D., Eriksson, L.I., et al. (eds.). Miller’s Anesthesia, 7th Edition. Philidelphia: Churchill Livingston 2009.