PARAVERTEBRAL
This is not a block that you should cut your teeth on, but it is the one that, in my opinion, has the most dramatic impact on the recovery of my patients. It is just awesome to speak to a patient after a thoracotomy that can take a deep breath and cough easily.. read more →
LUMBAR PLEXUS
I find this block to be one of the few, whether single injection or continuous, where the impact of ultrasound utilization is not as dramatic an improvement as it is with most other nerve blocks. This comes from a few different variables. One, it is usually a deep block, so visualization of structures.. read more →
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 →
INTERSCALENE
Converting from nerve stimulation to ultrasound for an interscalene nerve block classically involves going to a more posterior approach. This is also the case when changing from the traditional single injection to a continuous nerve block. For reasonable catheter securement issues as well as optimizing visualization with ultrasound, it becomes necessary to enter the skin several.. 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 →
Arteries through C5
Over and over again, I am reaffirmed of the of the ‘everyday advantages’ of utilizing ultrasound for peripheral nerve blocks. … REGISTER for FREE to become a SUBSCRIBER or LOGIN HERE to see the full article! 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 →