FEMORAL
The femoral nerve is seen to the left of the femoral artery and vein as a hyperechoic (white) triangle in the ultrasound image to the left. This is often one of the first nerve block to master with ultrasound because it is a relatively simple and superficial option and also probably because Total.. read more →
FASCIA ILIACA
I know I keep saying that this or that block is one of the ‘easy ones’, but this one really is another one of them. There are only a few simple essentials to identify on the image, and this block is also a good one to perform early as you are developing ultrasound.. read more →
SUBCOSTAL TAP
As I mentioned in the previous section, I believe that the subcostal TAP block is even easier than the TAP block. With the TAP block, the main difficulty is getting within (or just below or above) the fascial plane without puncturing the bowel. This can involve a significant amount of scraping or jabbing.. read more →
Tourniquet Issues #2
STYLE POINTS for Intercostobrachial Nerve Block I have mentioned elsewhere the need to cover the tourniquet site for an optimum effect. One of those sites is the inner upper arm for a tourniquet used for elbow, wrist and hand cases. This single shot block is usually used in combination with a supraclavicular or infraclavicular.. read more →
Total Shoulder, Bad Lungs
NOT MY USUAL STRATEGY I’ve mentioned elsewhere on this site that I have successfully taken care of many patients with this particular scenario, even those who are ‘oxygen-dependent’. The basic dilemma is whether to offer an interscalene block to someone that may have respiratory embarrassment due to spread to the phrenic nerve, knowing that without.. read more →
Tourniquet Issues
Many times, a quality nerve block could be considered a ‘failure’ or the anesthetic plan has to be altered because the use of or the exact position of the tourniquet was not considered. You KNEW the case warranted a nerve block or a continuous nerve block, and you knew the appropriate nerves to block.. read more →
CPNB for AKA
I have done continuous blocks in the past for post-operative analgesia (and to mitigate the risks of persistent pain and phantom pain and a multitude of other potential benefits) for amputations and as the primary anesthetic for foot amputations and BKA’s many times in the past. I have more consistently been performing CPNB’s.. read more →
Block Evaluation 3
WELCOME BACK! I have made a number of observations and recognized a number of patterns over the last several years working with nerve block patients. Here’s another I’d like to share. A point that I’ve made a dozen times in lecturing is that as you change or add techniques or processes, do so.. read more →
Block Evaluation 2
DON’T MUDDY THE WATER So, here you are in the PACU with a patient that just had a big surgery. The nurse called you here because the patient is hurting (“and I’m not sure your block is working, Doctor”). The patient is ‘mostly’ alert and says that they are hurting “over there”, pointing vaguely.. read more →
PACU Bypass
I have recently been inspired by one of my fantastic CRNA’s, Ashley Hayes, to begin bypassing the PACU, and it is kind of addicting, I have to say. I’ll go on record as saying that I know I broke one of my own rules of building up and preparing infrastructure in doing this, but.. read more →