Other Limb Blocks and Intravenous Regional Anesthesia

by Brian Warriner, MD

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    So there are many Other Regional Blocks and virtually, every portion of a limb can be blocked using a regional technique. So, it's possible to do multiple blocks on the upper limb and multiple blocks on the lower limb. The way we used to do this, the way I was taught to do it, was to feel for an artery, the assumption being that the nerves to a certain area were closely in contact with that artery, pass the needle towards the artery until the patient complained of an electric shock going down their arm or down their leg. Obviously, not a pleasant experience. At which point we would inject. The problem was that it failed a lot of the time. And if you actually got too close to the nerve and pierced the nerve, causing that paresthesia, that electric shock feeling, you could actually damage the nerve. And because we weren't seeing where the needle tip was going, even though we were trying not to hit the artery that we were palpitating at the same time, it wasn't unusual to hit the artery and for hematoma to form in the area. So it really wasn't a very satisfactory technique. And many of us, essentially, stopped using regional blocks for upper limbs and lower limbs because of that problem. About 10 years ago, the use of the nerve stimulator to identify the nerve position was introduced. And this has actually made the whole technique more successful, but still not as perfect as I'm going to show in a moment. With a nerve stimulator you start with a low current, usually around 10 amps, mA and you advance it towards the nerve, and you watch the patient's muscles to see if there's a twitch that goes along with the nerve you're...

    About the Lecture

    The lecture Other Limb Blocks and Intravenous Regional Anesthesia by Brian Warriner, MD is from the course Anesthesiology: Advanced. It contains the following chapters:

    • The Usage of the Nerve Stimulator
    • Brachial Plexus Blocks
    • Lower Limb Blocks
    • Intravenous Regional Anesthesia

    Quiz for lecture

    Test your knowledge with our quiz for lecture Other Limb Blocks and Intravenous Regional Anesthesia.

    1. Utilising ultra-sounded guided needle placement.
    2. Searching for paresthesiaes.
    3. Identifying and injecting around an artery after it has been pierced with the needle.
    4. Using purely external anatomic markers to identify the best place for injection of local anesthetic.
    1. Produced by using dilute local anesthetic in a limb which is isolated from the main circulation.
    2. Useful for all types of upper limb surgery.
    3. More rapidly and effectively produced with concentrated local anesthetics.
    4. Never produces systemic side effects.

    Author of lecture Other Limb Blocks and Intravenous Regional Anesthesia

     Brian Warriner, MD

    Brian Warriner, MD

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