upper extremity block
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Regional Nerve BlocksBenefts
•
Provide better post-op painmanagement
• Limit block to the body part undergoingsurgery
• Reduced need or other analgesicsopioids!
• "ecreased P#N$
•
%inimal side e&ects
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'onventional (echni)ue
• "efne area to be blocked
based on suracelandmarks
• *nsert stimulating catheter
• 'onfrm location +ith
nerve stimulator +atchingor appropriate motorresponse
• *n,ect anesthetic
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'onventional
Nerve Block
Procedures
are
perormed+ithout visual
guidance
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Role o Ultrasound Guidance• ee the target avoid the danger
– $isuali.e nerve and surrounding vascular/pleural
structures
• Provides real time guidance
• *mproves accuracy
• #bserve anesthetic spread• U guidance 0may1 prevent intraneural
in,ury and improve block saety ande&ectiveness
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Ultrasound 2ppearanceNerves can have 3 shapes4
• Round• #val
• (riangular
Peripheral Nerve
CervicalNerve Roots
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Ultrasound 2ppearance
Peripheral Nerve
CervicalNerve Roots
'ervical Roots
• %onoascicularappearance
• "ark5ypoechoic
Peripheral Nerves
•
5oneycombappearance
• 5yperechoic
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Needle 2ppearance
Needle shaft
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Ultrasound 2ppearance• *dentiy
ad,acentvascularstructures
•
6asy to identiy+ith 'olor"oppler
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Nerve Pre/Post *n,ection
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Nerve Pre/Post *n,ection
Nerve
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Nerve Pre/Post *n,ection
Nerve
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U Guided Nerve Blocks
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(ransducer Placement 1. Interscalene
2. Supraclavicular
3. Infraclavicular
4-5 Axillary
Picture rom 2nesthesiology 78839::4;
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*nterscalene 2pproach• Used to visuali.e roots o the
brachial ple=us• Brachial ple=us nerve lies in-
bet+een the anterior and middle
scalene muscles• 2ppear round to oval hypoechoic
structures
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Brachial Ple=us
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Brachial Ple=us
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Brachial Ple=us/*nterscalene
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Brachial Ple=us/*nterscalene
SCM
ASM
MSM
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Nerve Pre/Post *n,ection
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upraclavicular 2pproach• Block brachial ple=us at level o
the nerve trunks or divisions• 2ssociated +ith high level o
pneumothora=
•
Not generally recommended oroutpatients
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upraclavicular 2pproach
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ummaryUltrasound guidance• ho+s e=act nerve location•
ho+s vital structures surroundingnerves• Provides real-time guidance or needle
advancement•
*mproves accuracy• *dentifes local anesthetic spread• *ncrease patient satisaction
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“Regional AnesthesticTechniques have a failure rate ofup to 20% because of incorrectneedle and/or local anesthestic
placement.”
incent !han" 200# A $ractical uide to <rasound 'maging
(or $eripheral )erve *loc+s
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>uestions?