Block It Like It’s Hot: Regional Anesthesia, Pain Medicine & POCUS S2:E1 "Numb Hands & Our Top Finger-Tips: Nerve Blocks for Upper Limbs"
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Feb 20, 2024 Hosts discuss nerve block options for upper limb surgeries, optimizing techniques for precision and safety. They explore ultrasound guidance, tourniquet pain, opioid-free anesthesia, and the decision-making process for selecting nerve block techniques.
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Volume Guidance For Supraclavicular Blocks
- Use about 30 mL for supraclavicular blocks if you want reliable spread, but balance safety by staying extra-sheath.
- Consider splitting volume (e.g., 20 mL below, 10 mL above) to improve coverage.
Perivascular Technique: Scrape The 'Schmutz'
- For infraclavicular blocks, inject close to the axillary artery (six o'clock) and clear any echogenic 'schmutz' between needle and artery.
- Use 20–30 mL adjacent to the artery to encourage longitudinal spread to all three cords.
Costoclavicular Is A Mirror View
- The costoclavicular view often mirrors the supraclavicular appearance with cords clustered on one side of the artery.
- That clustering can make it an efficient spot to confirm cord position or to inject with smaller volumes.