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Regional Nerve Blocks

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

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  1. Regional Nerve Blocks Josh Major Anesthesia Clerkship

  2. 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.

  3. 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

  4. Contraindications • Absolute Contraindications: • Infection at site of block • Patient refusal • Allergy to local anesthetic • Relative Contraindications: • Medical anticoagulation or coagulopathy in deeper nerve blocks

  5. 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

  6. Upper Extremity Blocks

  7. 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

  8. Lower Extremity Blocks

  9. 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

  10. 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

  11. Major Nerve Block Drugs Major Nerve Blocks

  12. 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

  13. Complications • Block Failure • Perineural Hematoma • Infection • Nerve Injury • Intravascular Injection • Intraneural Injection • Excessively Dense Block

  14. References • Miller, M.D., Eriksson, L.I., et al. (eds.). Miller’s Anesthesia, 7th Edition. Philidelphia: Churchill Livingston 2009.

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