Nerve Blocks Steven Lanski, MD Assistant Professor Pediatrics and Emergency Medicine Emory...
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Nerve Blocks
Steven Lanski, MD
Assistant Professor Pediatrics and Emergency Medicine
Emory University
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What is Pain?
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What is Pain?
International Assoc for the Study of Pain: “an unpleasant sensory and emotional experience connected with actual or potential tissue damage…”
afferent impulses from averse stimuli
processing of that information
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Factors Involved
Thickness
Myelination
Perception
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Components of the Pain System: Sensation
Afferent fibers “A” delta fibers: mechanoceptors (pressure)
small, lightly myelinated …”first” pain rapid, sharp, localized
“C” fibers: polymodal (heat,chemical)unmyelinated (slower)…”second” paindelayed, prolonged, dull, poorly localized
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Mechanism of Action
Decreases sodium influx across neuronal membranes
Decreases polarization amplitude
No action potential
No impulse
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Duration of actionDependant upon protein binding and blood supply.
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Adverse Reactions
Cardiovascular - hypotension, bradycardia
CNS - excitatory - seizures
Allergic - preservative - methylparabenesters - tetracaine, benzocaine, procaine, cocaineamides - lidocaine, bupivacaine, diphenhydramine (1%)
Anxiety
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Locations
Facial Supraorbital and
trochlear infraorbital mental ear dental
Extremity digital radial median ulnar sural tibial
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Supraorbital/Supratrochlear Blocks
Helpful for multiple lacerations of forehead and anterior scalp
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Supraorbital/Supratrochlear Blocks
Landmark - superior orbital rim
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Infraorbital BlockAnesthesia to lower eyelid, lateral inferior
nose and lower lip
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Infraorbital Block
Landmarks - canine, infraorbital foramen
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Mental Nerve BlockAnesthesia to lower lip and partial
chin
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Mental Nerve BlockLandmark - 2nd bicuspid
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Auricular Block
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Dental Blocks
Local
Inferior Alveolar - anesthesia to the mandible, teeth and chin
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Inferior Alveolar Block
Landmarks - ramus of the mandible and coronoid notch
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Digital Blocks
Dorsal and palmar digital nerves
Toes (except 1st) single needle insertion
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Digital Blocks
Landmarks - bone and web space
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Thumb Block
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Median Nerve Block
Anesthesia to palm (radial half), 1st-3rd digits Landmark - proximal flexor crease, radial artery,
flexor carpi radialis and palmaris longus tendons.
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Ulnar Nerve BlockAnesthesia to dorsal and palmar aspect of hand (ulnar half), ulnar half of 4th digit and 5th digit Landmarks - flexor carpi ulnaris and ulnar artery
- dorso-ulnar aspect wrist (2nd branch)
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Radial Nerve BlockAnesthesia to dorsal surface of 1st-3rd digits and radial portion of hand Landmark – dorso-radial aspect of wrist
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Sural Nerve Block
Anesthesia to heel and lateral half of foot Landmarks - lateral malleolus, Achilles tendon
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Posterior Tibial Block
Anesthesia to the medial aspect of the foot Landmark - posterior tibial artery, Achilles tendon
and medial malleolus
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Penile Block
Landmarks - base of penis and Buck’s fascia
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Conclusion
Choice of agents based on duration required
Beneficial for multiple or extensive injuries in which conscious sedation will not be performed
More comfortable than local infiltration in some sites