Category Archives: Pain Management

Posterior Tibial Nerve Block – Technique

<< Posterior Tibial Nerve Block Technique Explain the procedure, benefits, risks, and complications to the patient and/or patient’s representative, and inform the patient of the possibility of paresthesia during the procedure. Obtain informed consent in accordance with hospital protocol. Perform and document neurovascular and musculoskeletal examinations prior to the procedure. Testing the posterior tibial nerve […]

Posterior Tibial Nerve Block

Introduction Pratitioners in the emergency department frequently encounter patients who have sustained trauma to the sole of the foot and require anesthesia for repair. This tender area is relatively difficult to anesthetize locally. Regional block of the posterior tibial nerve allows for rapid anesthetization of the heel and plantar regions of the foot. Regional blocks […]

Radial Nerve Block

Introduction Radial nerve block is a simple procedure that can be performed at various levels along the course of the radial nerve. Surgical anesthesia, postoperative analgesia, and palliative measures for acute painful conditions are all indications for radial nerve block. Radial nerve anatomy The radial nerve is 1 of the 4 important branches of the […]

Median Nerve Block

Introduction Median nerve blocks at the wrist, either alone or in combination with blockade of the ulnar and radial nerves, are useful emergency department (ED) procedures. Compared to local anesthesia, nerve blocks provide greater efficacy and coverage of anesthesia useful for more complicated wounds or procedures involving the hand. In general, adequate anesthesia is a […]

Topical Anesthesia

Topical Anesthesia

Overview Many options to deliver anesthesia have developed over the last several decades. Administration of topical anesthetics to control pain associated with procedures such as laceration repair may avoid the need for infiltrative local anesthesia injections and associated pain from the injections. Topical anesthesia also avoids the risk of wound margin distortion that exists with […]

Digital nerve blocks

Introduction Digital nerve blocks are important tools for the emergency medicine clinician. Injuries or infections of the digits are extremely common. Adequate analgesia is essential to properly address the presenting condition and to minimize the patient's discomfort. Digital blocks are useful in many scenarios in which local infiltration of an anesthetic would require several injections […]



Anesthesia Local anesthetics are classified into 2 groups: the ester group and the amide group. The classification is based on the chemical structure of the intermediate chain. This structural difference affects the pathway by which local anesthetics are metabolized and the allergic potential. Ester anesthetics are listed in the Table below. They are metabolized by hydrolysis, […]

Local and Regional Anesthesia

Local And Regional Anesthesia

Introduction Local anesthetics provide a reversible regional loss of sensation. Local anesthetics reduce pain, thereby facilitating surgical procedures. Delivery techniques broaden the clinical applicability of local anesthetics. These techniques include topical anesthesia, infiltrative anesthesia, ring blocks, and peripheral nerve blocks. Local anesthetics are safer than general or systemic anesthetics; therefore, they are used whenever possible. […]