Page 143 - Journal of Special Operations Medicine - Spring 2017

Appendix E Cont.

REGIONAL ANESTHESIA REFERENCE - ULTRASOUND-GUIDED NERVE BLOCKS

• TIPS: identify subclavian artery lying on
the first rib; the plexus is immediately
lateral and superficial to it.
• PITFALLS: keep needle tip always in
sight to avoid pneumothorax, and don’t
point below the first rib.
• INJECTION VOLUME: 20-25mL

• TIPS: identify axillary artery;
musculocutaneous nerve is distant
from the plexus bundles.
• PITFALLS: there are multiple vessels in
this area - avoid intravascular injection.
• INJECTION VOLUME: 15-20mL

• TIPS: identify femoral artery; femoral
nerve is lateral to it; pop the iliac fascia,
target the nerve prior to bifurcation of
the femoral artery.
• PITFALLS: beware of motor weakness
of quadriceps - fall risk!
• INJECTION VOLUME: 10-20mL

• TIPS: identify greater trochanter and
ischial tuberosity; sciatic nerve can be
seen between them.
• PITFALLS: may need to inject more
distally or in long axis of the nerve.
• INJECTION VOLUME: 15-20mL

• TIPS: identify
popliteal vessels;
inject at
confluence of
CPN & TN; scan
after injection to
ensure spread.
• INJECTION
VOLUME: 20mL TARGET
GENERAL POINTERS ON TECHNIQUE: • Deposit a small amount of local anesthetic to hydro-dissect the nerve from its
surrounding tissues - this hydrolocalization technique will help you see it better;
• In cross-section on ultrasound nerves look like honey-comb cereal; • Flush the needle with local anesthetic prior to injection, in order to avoid injecting
• Find blood vessels and use color Doppler to localize associated nerves; air and resultant poor image quality from artifacts caused by air;
• Best find the nerve in cross-section & approach with needle-in-plane; some blocks • Local anesthetics are lipophilic - do not simply deposit into surrounding fat tissue.
can be done out-of-plane; to see the needle well, avoid steep needle angles in-plane;
• Pop the fascial plane - tight needle-tip-to-nerve proximity is not as important, if you LINEAR PROBE IS PREFERRED
are within the right fascial plane; LINEAR PRIMARY CONTRIBUTORS:
Katarzyna (Kasia) Hampton, MD; James Reed, CRNA; SFC William H. Poston, 18D

Guidelines: Analgesia and Sedation During PFC 119