Peripheral Nerve Blocks

When to block:

• Primarily used for analgesia in specific anatomic locations

Patients presenting with:

• Lacerations, fractures, dislocations, foreign body removal

Steps to Performing a Block:

• Obtain consent
• Document neurovascular exam
• Review anatomy
• Review block/procedure
• Place ultrasound machine in direct sight line
• Note critical internal structures (arteries, lungs, etc.)
• Optimize your image
• Sterile prep/technique
• Visualize needle tip throughout the procedure
• Aspirate before injection
• Visualize placement of anesthetic
• Document procedure
• Reassess patient (5-45 minutes depending on block)

Sterile Technique:

• Blocks should be performed under sterile/semi-sterile technique
• Clean probe and ultrasound machine
• Have ultrasound machine at proper depth and anatomy landmarked
• Clean/prep area with chlorhexidine/antiseptic x 3
• Use sterile gloves/gown
• Place sterile ultrasound probe cover (some practitioners use a tegaderm for sterile barrier)
• Consider local anesthetic prior to performing nerve block

Amount of Anesthetic:

• Depends on the location and type of block
• Use weight-based calculation (mg/kg)
• For a helpful chart on max doses, see the Highland EM ultrasound page

Local Anesthetic Systemic Toxicity (LAST):

• Visit the BC PoCUS LAST page
• Know where the crash cart is kept
• Know where lipid emulsion is kept
• Monitor patient on cardiac monitor for 30-60 min.
• Monitor for central nervous system and cardiovascular instability