Surrounding plexus with local

[Sonny Crocket]

---

Members don't see this ad.

When doing Ultrasound guided nerve blocks, is your practice to make sure that you surround the nerve or plexus on all sides of it? I seem to remember during residency that some of my teachers were really into this. Others were happy to hit one side of it staing that it is safer ( due to less needle movement ) and just as effective.

 

[BLADEMDA]

http://forums.studentdoctor.net/showthread.php?t=981475&highlight=supraclavicular

Please read this thread

 

[BLADEMDA]

When doing Ultrasound guided nerve blocks, is your practice to make sure that you surround the nerve or plexus on all sides of it? I seem to remember during residency that some of my teachers were really into this. Others were happy to hit one side of it staing that it is safer ( due to less needle movement ) and just as effective.

Here is what we know:

1. The published data shows that a high volume U/S guided block only requires you to place local in one location (each block has a particular spot) for excellent success. Our data as a specialty over the past 30 years using only a nerve stimulator backs up this newer u/s data.

2. Safer- There is no published evidence proving a multiple injection technique under u/s is any less safe than doing a single injection technique.

My personal failure rate was 2% or so using the Single injection technique and is less than 1% using the multiple injection one. Hence, I choose the latter provided I have a good view of the needle and the nerve. On occasion, I do use a single injection technique if the patient anatomy and u/s views warrant that approach.

Again, the peer reviewed published data shows a single injection with most, if not all, of our u/s guided blocks will have the same success rate as a multiple injection technique provided a sufficient volume of local is utilized and the needle is placed in exactly the right location.

 

[Sonny Crocket]

Thanks for the reply. I see the point with multiple injections for a supraclavicular block. However, lets say you are doing a selective tibial block for example, is it really necessary to have circumferential local distribution? I'm thinking not.

 

[Mman]

Thanks for the reply. I see the point with multiple injections for a supraclavicular block. However, lets say you are doing a selective tibial block for example, is it really necessary to have circumferential local distribution? I'm thinking not.

circumferential spread speeds the onset on the block by a decent amount IMHO. You don't have to wait for time to spread and cover everything. My supraclavicular blocks are generally starting to work within about 60-90 seconds and surgical anesthetic levels within 4-5 minutes or so which is much faster than I get with single site of injection.

 

[BLADEMDA]

A Multiple injection technique does speed up the onset of the block; but, for most of our postop pain blocks this is not a big deal.

I do utilize a multiple injection technique for tibial and popliteal blocks most of the time,

 

[Mman]

A Multiple injection technique does speed up the onset of the block; but, for most of our postop pain blocks this is not a big deal.

I do utilize a multiple injection technique for tibial and popliteal blocks most of the time,

I agree that speed of onset is more important for surgical anesthesia, not for postop pain if a patient is groggy from GA.

 

[Sonny Crocket]

So you guys are saying for a single shot block with GA in addition, just hit one side of the nerve if I want. Post op analgesia will be the same. And probably intra op analgesia as well.

 

[BLADEMDA]

The data indicates that after a single injection with sufficient volume the spread of the local should occur around the nerve or plexus. Do not attempt low volume blocks with the single injection technique.

Each particular nerve block may have an optimal "spot" for a single injection technique. For example, a Popliteal block can be accomplished with a single injection between the Tibial and Common Peroneal Nerves just as they divide. The injection is right between the nerves (shared paraneuaral sheath).
Or, an ISB can be placed near C6 and 20-30 mls of local placed at that location which will spread around the nerve root brachial plexus (C5-C7)

 

[caligas]

circumferential spread speeds the onset on the block by a decent amount IMHO. You don't have to wait for time to spread and cover everything. My supraclavicular blocks are generally starting to work within about 60-90 seconds and surgical anesthetic levels within 4-5 minutes or so which is much faster than I get with single site of injection.

But with a supraclav. there is no single nerve to circle so you sort of have to inject at a few spots right?

 

[BLADEMDA]

But with a supraclav. there is no single nerve to circle so you sort of have to inject at a few spots right?

http://forums.studentdoctor.net/showthread.php?t=981475&highlight=supraclavicular

Read the ENTIRE thread please. See post number 32. If you have any questions then post them after reading the thread.