NERVE BLOCKS
DR.S.ARUN CHEGUEVARA
INDICATIONS :
• Better wound closure
• Compromising blood flow
• Large area of anaesthesia
• Better efficacy
• Extensive repairs or manipulation needed
GENERAL MEASURES EMPLOYED DURING NERVE BLOCK :
• Lying the patient down (fainting is common)
• Warming the local anaesthetic to reduce the pain of injection
• Considering the use of ultrasound guidance or other nerve locator devices
• Sterile precautions and appropriate cleaning of the injection site
• Using a narrow-gauge needle where possible to reduce the pain of injection
• Aspirating frequently to avoid intravascular injection
• Asking the patient about tingling in the distribution of the nerve.
Paraesthesia is not the goal and if elicited the needle should be withdrawn
2–3 mm before injecting
• Injecting slowly and not forcing the syringe to reduce the pain of injection
and avoid intra-axonal injection
• Maintaining a conversation with the patient to detect early signs of toxicity
CHOICE OF ANAESTHESIA :
• Bupivacaine 0.25%
• 1% lidocaine with epinephrine
• Instructions
• Equipment
• Positioning
• Choice of anaesthesia
• Area preparation
• Choosing nerve to block
• Injecting the anaesthesia
• Complications
COMPLICATIONS :
• Nerve injury
• Intravascular injection
• Hematoma
• Infection
• Limb injury
INTERCOSTAL NERVE BLOCKS
ELBOW NERVE BLOCK
WRIST NERVE BLOCK
DIGITAL NERVE BLOCKS
FEMORAL BLOCK
NERVE SUPPLY OF FOOT AND ANKLE :
• Saphenous nerve –medial side of ankle
• Superficial peroneal nerve – front of ankle and dorsum of foot
• Deep peronael nerve – lateral side of big toe and medial side of 2nd toe
• Sural nerve – heel and lateral side of hind foot
• Tibial nerve – medial and lateral plantar nerve – anterior half of sole
SAPHENOUS NERVE :
• Infiltrate subcutaneously around great saphenous vein , anterior and just proximal to
medial malleolus .
SUPERFICIAL PERONEAL NERVE :
• Infiltrate local anaesthetic subcutaneously above the ankle joint from the anterior
border of the tibia to the lateral malleolus.
DEEP PERONEAL NERVE :
• Inject above the ankle joint between the tendons of tibialis anterior and extensor
hallucis longus.
SURAL NERVE :
Lie the patient prone and infiltrate subcutaneously from lateral border of
Achilles tendon to the lateral malleolus
TIBIAL NERVE :
Patient in prone position , inject medial to Achilles tendon and level with
proximal edge of medial malleolus , just lateral to posterior tibial artery .
THANK YOU
