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Category: Nerve Block

Saphenous Nerve Block

Saphenous Nerve Block

Introduction Clinicians in the emergency department and other acute care settings frequently encounter patients who have sustained trauma to the lower leg or foot and require anesthesia for repair. Regional block of the saphenous nerve, a pure sensory nerve of the leg, allows for rapid anesthetization of the anteromedial lower extremity, including the medial malleolus. Regional blocks have several advantages compared with local infiltration, such as fewer injections required to attain adequate anesthesia, smaller volume of anesthetic required, and less…

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Superficial Peroneal Nerve Block

Superficial Peroneal Nerve Block

Introduction Emergency practitioners and other clinicians working in acute care settings frequently encounter patients who have trauma to or pathology of the dorsum of the foot and require anesthesia for treatment and repair. Regional block of the superficial peroneal nerve allows for rapid anesthetization of the dorsum of the foot, which allows for management of lacerations, fractures, nail bed injuries, or other pathology involving the dorsum of the foot. Regional blocks have several advantages compared to local infiltration, such as fewer injections…

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Posterior Tibial Nerve Block – Technique

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 prior to block includes the following: Sensation of sole of the foot, as shown below Flexion, abduction, and adduction of the digits Using nonsterile gloves,…

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Posterior Tibial Nerve Block

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 have several advantages compared to local infiltration, such as fewer injections necessary to attain adequate anesthesia, smaller volume of anesthetic required, and less distortion of…

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Radial Nerve Block

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 posterior cord of the brachial plexus and has the root values of C5, C6, C7, C8, and T1. The mnemonic STAR (Subscapular, Thoracodorsal, Axillary, Radial)…

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Median Nerve Block

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 prerequisite to proper irrigation, examination, and repair of all wounds. The median nerve can be blocked at multiple sites along its passage through the upper…

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Deep Peroneal Nerve Block

Deep Peroneal Nerve Block

Introduction Deep peroneal nerve block is one of the 2 deep nerve blocks at the level of the ankle. The deep peroneal nerve block is easy to perform and may constitute part of an ankle block. The deep peroneal nerve block is useful for anesthesia and postoperative analgesia to surgeries of the first web space (eg, Morton neuroma). It can also be used to treat chronic pain conditions like anterior tarsal tunnel syndrome. Anatomy The common peroneal nerve (root values:…

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Digital nerve blocks

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 into the already painful site of injury. Furthermore, local infiltration around the wound may create increased swelling, making the repair more difficult. Several techniques are…

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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. In addition, they are relatively easy to administer and readily available. Local anesthetics have been undergoing development for centuries, and, as this article illustrates, research…

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Trigger Point Injection for Pain Management

Trigger Point Injection for Pain Management

Trigger point injection (TPI) may be an option in treating pain for some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body. What Happens During Trigger Point Injection? In…

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