INFRACLAVICULAR
As I have mentioned in other places on this website, I have traditionally been more of a supraclavicular than an infraclavicular block fan. A recent conversation (rather, a friendly argument) gave me enough pause to look again at this technique. I will cut to the chase and say that I still have no good.. read more →
Questions about Upper Extremity Blocks Answered
The following dialogue was generated through the CPNBconsulting.com website. This was initiated by a regional anesthesia enthusiast in Bangalore, India who had some questions for Dr Jones on upper extremity nerve blocks. Dear Sir, I had a few queries to clear from you: 1. Why after a supraclavicular block, are patients still be able.. read more →
Ultrasound Skills Development
Training Reps and Game-Time Experience I love this time of year when college football is closing in and all the hype about ‘what could be’ is at a peak. Last minute decisions are being made to determine who key starters are going to be and who will get the precious remaining ‘training reps’ with.. read more →
Acute Compartment Syndrome (ACS)
“What are the odds?” I have discussed in lecture and in conversation the reasonable consideration of continuous peripheral nerve blocks when ACS is a potential risk and strategies we can utilize to optimize patient care and minimize the possibility of delaying the diagnosis of ACS. I was pleased to see this topic discussed in.. read more →
Block Evaluation 4
“Doctor, you’re block isn’t working…..” I get calls to the PACU and get told while rounding on my patients that a patient is hurting. If you are proficient at doing blocks and focused on optimizing pain control, you probably have to briefly fight the urge to say, “They can’t be hurting…I put that block in!”.. read more →
TAP Block Pain Evaluation
WHERE are you hurting??? It is critically important that you evaluate closely the location (and quality) of your patient’s pain before recommending changes in therapy or deciding whether your TAP or Subcostal TAP block is functioning properly. Without proper evaluation (and elucidating in the chart or face to face), your block may be.. read more →
Recognizing Appropriate Fascia Iliaca Spread: Watch this Video!
There is NO Doubt! This fascia iliaca video shows several key ultrasound cues that should always lead you to a successful nerve block. After the needle is advanced in a cranial direction, the initial injection reveals a very thin distribution of local anesthetic which does not inject easily (noted by assistant). Further, upon this injection,.. read more →
Fascia Iliaca Tips #2
THE SPREAD Usually, the Fascia Iliaca and Fascia Lata are clearly identifiable next to the thinner and less echogenic muscle fibers of the Sartorius and Iliopsoas muscles. There are times, however, when the deeper border of the Sartorius muscle blends in well or the exact position of the tip of your needle is difficult to.. read more →
TAP
Though the TAP block tends to be one that people venture into after they have started with at least a few of the orthopedic blocks, I would recommend putting it on the short list of blocks to learn even if you are just starting to use ultrasound. It is a very easy block.. read more →