Recent advances in various surgical techniques and the development of more minimally invasive procedures have spurred an increase in outpatient procedures. With these developments, it requires that analgesic techniques keep pace with these surgical advancements. Studies have shown that peripheral nerve blocks are usually well-tolerated and provide regional analgesia superior to other modalities such as oral pain medications or general anesthesia.
Anatomy and landmarks depend on the type of block being performed. Please refer below to techniques for specifics to the more common peripheral nerve blocks performed.
There is no strict set of guidelines for the use of peripheral nerve blocks. However, the general rationale is to implement regional blocks in cases where conservative measures have failed or to avoid the side effects and complications of general anesthesia and oral medications. The following include examples of where peripheral nerve blocks may be preferable:
Absolute contraindications to the use of peripheral nerve blocks include allergy to local anesthetics, inability to cooperate, or patient refusal. It is advised to postpone or reconsider a nerve injection when there is an active infection at the injection site, pre-existing neural deficits along the distribution of the block, and in patients with coagulopathies or on antithrombotic drugs.
Equipment that is used is dependent upon the type of technique utilized. The following is a list of equipment used based on technique.
A well-versed medical professional that is highly familiar and experienced with the type of block being performed should be performing the specific injection.
Taking a detailed medical history is necessary to determine conditions like coagulopathy or respiratory compromise that may impact the decision to perform a block. A thorough physical exam is prudent as well to determine preexisting sensory or motor deficits in the distribution of the block. Studies show that patients with preexisting sensory or motor deficits may be more likely to develop new deficits following a block than patients without preexisting deficits. Following the history and physical, the patient should be made familiar with the risks, benefits, and care needed during the recovery phase of the block.
For patients that are receiving a nerve block for a surgical procedure, they should follow the same fasting guidelines for the surgery as it may be necessary for deep sedation to be used in cases of an inadequate block. Also, intravenous access should be obtained due to the risk of potential complications like vasovagal events, local anesthetic toxicity, and the possible use of general anesthetics.
The technique for peripheral nerve blocks is based on the type of block. A quick summary of some of the more common blocks is listed below.
Potential complications and side effects are dependent upon the type of block performed. However, complications include peripheral nerve injury (although not common, the rate may be as high as 8% to 10%), hematoma, local anesthetic systemic toxicity, allergic reaction, infection, and a secondary injury, which includes reduced sensation after nerve block.
Peripheral nerve blocks are often performed by anesthesiologists, surgeons, and emergency department physicians. However, a dedicated nurse must monitor the patient's vital signs during the procedure. More important, resuscitation equipment must be in the room before starting the procedure. A protocol should be established to conduct a peripheral nerve block to ensure patient safety and improve patient outcomes.
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