John P. McDonough, CRNA, Ed.D., ARNPJohn P. McDonough, CRNA, Ed.D., ARNPProfessor & DirectorProfessor & Director

Anesthesiology NursingAnesthesiology Nursing

Peripheral & Other Blocks

Interscalene BlcokInterscalene Blcok

Know the anatomy!Know the anatomy! Nerve stimulator improves resultsNerve stimulator improves results

– Good biceps twitch down to 0.5 mVGood biceps twitch down to 0.5 mV Good for shoulder and upper arm Good for shoulder and upper arm

procedures procedures Volume is crucial Volume is crucial Use immobile needle techniqueUse immobile needle technique

Stellate Ganglion BlockStellate Ganglion Block

Sympathetic block onlySympathetic block only– CRPS (aka- RSD)CRPS (aka- RSD)– Digit replantation surgeryDigit replantation surgery– Herpes zoster Herpes zoster – Frostbite Frostbite

Volume is crucial Volume is crucial Use immobile needle techniqueUse immobile needle technique

Intercostal Nerve Block Intercostal Nerve Block

Know the anatomyKnow the anatomy Small needlesSmall needles

– 25 G usually adequate 25 G usually adequate Analgesia Analgesia

– TraumaTrauma– Post surgery painPost surgery pain

Sciatic Nerve BlockSciatic Nerve Block

Lower extremity surgery below the knee Lower extremity surgery below the knee Combined with “3 in 1” or other blocks of Combined with “3 in 1” or other blocks of

the femoral obdurator and saphenous nervesthe femoral obdurator and saphenous nerves

Ankle BlockAnkle Block

3 major nerves are required3 major nerves are required– Tibial Tibial – Deep peroneal Deep peroneal – Superficial peroneal Superficial peroneal

Usable for foot surgeryUsable for foot surgery

Blocks for hand surgeryBlocks for hand surgery

Nerve supply to the handNerve supply to the hand– RadialRadial– MedianMedian– Ulnar Ulnar

No motor block to digitsNo motor block to digits

Caudal BlockCaudal Block

Sacral epidural Sacral epidural Used for: Used for:

– rectal surgeryrectal surgery– pain blockspain blocks

Volume is essentialVolume is essential