Ankle Blockade

Ankle blockade is a safe, efficacious, and well-tolerated anesthetic for foot and ankle surgery The following aspects of the procedure are reviewed: clinical applications, relevant anatomy, patient position, technique (including neural localization techniques, needle insertion site, and needle redirection cues), and side effects and complications.

Sciatic Nerve Blockade

Sciatic nerve blockade is performed to achieve anesthesia and analgesia of the distal lower extremity, including the anterior and posterolateral leg, ankle, and foot. The following aspects of the procedure are reviewed: clinical applications, relevant anatomy, patient position, technique (including neural localization techniques, needle insertion site, and needle redirection cues), and side effects and complications. Use of ultrasound guidance is also discussed.

Wrist Blockade

Wrist blockade anesthetizes the median, ulnar, and radial nerves at the level of the wrist. The following aspects of the procedure are reviewed: clinical applications, relevant anatomy, patient position, technique (including neural localization techniques, needle insertion site, and needle redirection cues), and side effects and complications.

Intersternocleidomastoid Blockade

The intersternocleidomastoid block is indicated for procedures of the shoulder, upper arm, and forearm. The following aspects of the procedure are reviewed: clinical applications, relevant anatomy, patient position, technique (including neural localization techniques, needle insertion site, and needle redirection cues), and side effects and complications.

Anatomical Considerations for Peripheral Nerve Blockade

Chapter 5 contains a basic review of terminology used to describe body planes, surface orientation, and movements. The anatomy of major nerve plexuses are also examined: brachial plexus, lumbar plexus, lumbosacral plexus. The chapter concludes with a discussion of peripheral nerve anatomy and sensory and motor innervation, including dermatomes, osteotomes, and myotomes.

Digital Blockade

Digital nerve blocks are used to provide anesthesia to one or more fingers or toes The following aspects of the procedure are reviewed: clinical applications, relevant anatomy, patient position, technique (including neural localization techniques, needle insertion site, and needle redirection cues), and side effects and complications.

Suprascapular Blockade

Suprascapular blockade provides analgesia of the shoulder joint, capsule, and skin without anesthetizing the phrenic nerve. The following aspects of the procedure are reviewed: clinical applications, relevant anatomy, patient position, technique (including neural localization techniques, needle insertion site, and needle redirection cues), and side effects and complications.

Sonoanatomy of the Upper and Lower Extremity

Ultrasound-guided regional anesthesia is the practice of applied anatomy. A detailed knowledge of neuroanatomy and the relationships of nerves to other structures is critical to successfully perform ultrasound-based procedures. In addition to anatomical knowledge, a comprehensive understanding of ultrasound equipment, probe selection, image optimization, and scanning technique is also essential to the proceduralist. Each of these factors is reviewed.

Complications of Peripheral Nerve Blockade

Most complication associated with peripheral nerve blockade fall into one of three categories: neurologic, hemorrhagic, or infectious. Most neurologic complications are attributable to mechanical trauma or local anesthetic toxicity. Patient, procedure, and anesthetic risk factors are reviewed. Hemorrhagic complications include bruising and hematoma formation. Single-injection and continuous catheter techniques are discussed. The possible role of catheters in infectious complications of nerve blockade is examined.

Pharmacology of Neural Blockade

Chapter 2 reviews the mechanism of action for local anesthetics. Clinical features such as potency, onset of action, duration, and dose are discussed. Drug metabolism, toxicity (local and systemic), and its treatment are included. The chapter concludes with additional information on adjuvant medications (eg, epinephrine, clonidine) used to extend or enhance the clinical effects of local anesthetics.