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 →
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 →
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 →
SUBGLUTEAL SCIATIC
The subgluteal approach is where I first started blocking the sciatic nerve for total knee arthroplasty (TKA). Since I usually performed the subgluteal sciatic nerve block as a single injection (and some of the extra steps for a continuous block could be omitted) after the continuous femoral block was already secured in place,.. read more →
SAPHENOUS
This is an often overlooked nerve block for ankle and foot procedures. This furthest extension of the femoral nerve has no motor component. It serves sensory innervation to the medial aspect of the calf including the ankle and some degree of the medial aspect of the forefoot. It also has a small contribution.. read more →