Regional Blocks

Ankle Block

An ankle block is used for some common surgical procedures on the fore-foot, the mid-foot, or the heel. After sedation/analgesia is administered, the ankle is cleaned with iodine solution. A few injections (usually 3-5) are performed at the ankle and upper foot area. This procedure numbs the entire foot.

Axillary Block

An axillary block is one of the most useful and commonly used regional block techniques for surgery of the hand, wrist, forearm or elbow. It is a nerve block of the arm at the level of the axilla (armpit). A patient is placed on the operating room table and light sedation/analgesia is administered. The arm is positioned above the shoulder and bent at the elbow joint. Then skin in the axilla is cleaned with iodine solution and the axillary artery is located by feeling for the pulsation. A small needle is introduced and local anesthetic is deposited behind the artery. The procedure is finished by applying pressure for 5-7 minutes. The arm and hand will become numb and the patient will be unable to move them for many hours.

Epidural, Spinal, and Combined Spinal-Epidural Anesthesia

Combined spinal-epidural, epidural, and spinal anesthesia are excellent anesthesia techniques for patients undergoing hip or leg surgery. The patient is positioned either on their side or sitting up, the back is cleaned with an iodine solution and the skin is anesthetized with a small amount of local anesthetic.

In the combined spinal-epidural technique, an epidural needle is inserted in the epidural space, and a spinal needle is then inserted through the epidural needle. At this point, the desired dose of local anesthetic is injected. The spinal needle is withdrawn and an epidural catheter is inserted. Once the epidural needle is withdrawn, the catheter is secured in place with a dressing.

In an epidural technique, an epidural needle is inserted in the epidural space, and an epidural catheter is placed through the needle. Once the epidural needle is withdrawn, the catheter is secured in place with a dressing. Local anesthetic is injected through the epidural needle and/or the epidural catheter.

In the spinal anesthesia technique, the spinal needle is inserted through the skin, local anesthetic is injected and the needle is removed.

All three of these techniques will block all sensation and movement below the waist for many hours.

Femoral Nerve Block

Common indications for use of femoral nerve block for surgery include knee arthroscopy, ACL (anterior crucate ligament) reconstruction, total knee replacement, surgeries involving the kneecap (patella) and front thigh, and postoperative pain management after those operations. The patient is positioned on their back. After the skin in the groin area is cleaned with an iodine solution, a small needle is placed at the top of the leg. The nerve is identified by the twitches of the kneecap and a local anesthetic is injected. This will numb the front of the thigh and part of the lower leg for many hours thus decreasing pain after the surgery when the anesthesia has worn off.

Interscalene Block

Surgery on the shoulder joint, clavicle, and upper arm can be performed under an interscalene block. A patient is positioned supine (on their back) and the head is turned to the side. The skin on the side of the neck is cleaned with iodine solution and a small needle is inserted. The patient is asked if they feel any new sensation in their shoulder or arm (this can be a subtle sensation like a small twitch or something more obvious like a "funny-bone" sensation). At that point, local anesthetic is injected and the shoulder and arm will become completely numb.

posted 8/26/2004