Tourniquet Issues #2

October 7, 2012

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 block. It is helpful for general anesthetic cases, but it is mandatory for awake/sedation anesthetic techniques. It is an extra security measure when trying to skip the PACU. I would like to introduce you to a few tricks that will guarantee success with a minimum of effort and minimal discomfort to your patient.

I will typically arrive in the O.R. as the patient monitors are being placed and the first titrations of sedation are drifting in the IV. The brachial plexus block has been in for place for more than enough time to have set up fully at this point. Certainly, this can be done at the conclusion of the first block in the holding or block room, but it takes only seconds, and I am using time to my advantage here as I let the brachial plexus block extend maximally. While the patient is awake enough to communicate with me, I use …

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continuous nerve block, evaluation, nerve block, nerve block evaluation, patient evaluation, strategy, tourniquet, tourniquet pain

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