
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 →

Phrenic Nerve Dysfunction after ISB: my response to Recent Anesthesiology editorial
The following is my response as posted on PRACTICE OF REGIONAL ANESTHESIA on LinkedIn to: Phrenic Nerve Function After Interscalene Block Revisited: Now, the Long View by Hogan, Quinn H. M.D. Anesthesiology 119(2):250-252, August 2013 At first glance, this editorial and article were very concerning to me. As a profession, we do not have long-term.. 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 →

SUPRACLAVICULAR
Above, you can see a needle advancing from the left of the image and piercing the middle scalene muscle to approach the ‘corner pocket’ at 2 cm depth. The muscle is indistinct due to the very steep angle at which it is being viewed. The ‘corner pocket’ is at the intersection of the rib, artery.. 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 →