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Supraclavicular Brachial Plexus Block

Upper Extermity

Figure 1: Insertion of the needle in the supraclavicular brachial plexus block. The needle is inserted lateral to the insertion of the clavicular head of the sternocleidomastoid muscle. Essentials Indications: upper extremity surgery (arm, elbow, forearm, wrist, hand) Landmarks: the…

Infraclavicular Brachial Plexus Block

Upper Extermity

Figure 1: Patient position and needle insertion for infraclavicular brachial plexus block. Essentials Indications: elbow, forearm, hand surgery Landmarks: medial clavicular head, coracoid process Nerve stimulation: hand twitch at 0.2-0.5 mA Local anesthetic: 25-35 mL General Considerations The infraclavicular block…

Axillary Brachial Plexus Block

General

Figure 1: The needle is inserted toward the axillary artery (line) until either motor response of the hand or arterial blood on aspiration is obtained. Essentials Indications: forearm and hand surgery Landmarks: axillary artery pulse Any of the following three…

Wrist Block

General, Upper Extermity

A B Figure 1: (A) Technique to accomplish a wrist block. (B) Median nerve block. Needle is inserted medial or lateral to the flexor palmaris longus tendon and carefully advanced to avoid paresthesia. Then 5 mL of local anesthetic is…

Cutaneous Nerve blocks of the Upper Extremity

General

A B C Figure 1: Techniques to block the cutaneous nerves of the upper extremity. Essentials Indications: mostly used as a supplement to major blocks of the upper extremity Local anesthetic: 5-10 mL General Considerations Cutaneous nerve blocks of the…

Sciatic Nerve Block: Transgluteal / Anterior Approach

Lower Extermity

A B Figure 1-1: (A) Needle insertion for the transgluteal (posterior) approach to sciatic nerve block. (B) Needle insertion for anterior sciatic block. Essentials Transgluteal (Posterior) Approach Indications: surgery on the knee, tibia, ankle, and foot Landmarks: greater trochanter, superior…

Femoral Nerve Block

Lower Extermity

Figure 1: Needle insertion for femoral nerve block. Essentials Indications: surgery of the anterior thigh and knee surgery Landmarks: femoral (inguinal) crease, femoral artery pulse Nerve stimulation: twitch of the patella (quadriceps) at 0.2-0.5 mA Local anesthetic: 15-20 mL Figure…

Ankle Block

Lower Extermity

Figure 1: Needle insertion for saphenous nerve block of the ankle. Essentials Indications: surgery of the foot and toes Two deep nerves: posterior tibial, deep peroneal Three superficial nerves: superficial peroneal, sural, saphenous Local anesthetic: 5-6 mL per nerve General…

Spinal and Epidural Block

Ultrasound Guided

Authors: Wing Hong Kwok and Manoj Karmakar Introduction Ultrasound scanning (US) can offer several advantages when used to guide placement of the needle for centroneuraxial blocks (CNBs). It is noninvasive, safe, simple to use, can be performed expeditiously, provides real-time…

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