Anesthesia/Analgesia


Auricular Nerve Block

Rapid Review

  • Background
    • Injection of local anesthetic around the sensory nerves of the ear (greater auricular nerve, lesser occipital nervous, auricular branch of vagus nerve, and auriculotemporal nerve) for anesthesia of the entire ear
  • Indications
    • Ear laceration repair, I&D of abscess or auricular hematoma
  • Contraindications
    • Overlying infection, allergy to local anesthetic, coagulopathy
  • Complications
    • Inadequate anesthesia, infection, vascular injury

Pearls

Video Credit: EMRAP


Digital Nerve Block

Rapid Review

  • Background
    • Injection of local anesthetic into the base of the finger or toe to accomplish regional anesthesia. 
  • Indications
    • Laceration repair, nail trephination, dislocation/fracture reduction, paronychia/felon.
  • Contraindications
    • Distortion of landmarks, overlying skin infection
  • Complications
    • Unintentional intravascular injection, bleeding, infection

Pearls

Video Credit: Core EM


Femoral Nerve Block

Rapid Review

  • Background
    • Injection of local anesthetic around the femoral nerve for anesthesia of the anterior thigh, knee, medial lower extremity below the knee
  • Indications
    • Femur fracture, femoral neck fracture, patella fracture 
  • Contraindications
    • Overlying infection, allergy to anesthetic
  • Complications
    • Nerve injury, infection, hematoma, allergic reaction

Pearls

Video Credit: NYSORA


Hematoma Block

Rapid Review

  • Background
    • Injection of local anesthetic into the hematoma surrounding a fracture site when reduction or manipulation is required. 
    • Used as an alternative to procedural sedation.
  • Indications
    • Reduction or manipulation of fracture site. 
    • Commonly used in wrist and ankle fractures
  • Contraindications
    • Complex or open fractures
  • Complications
    •  Inadequate analgesia, vascular injury, infection

Pearls

Video Credit: Larry Mellick


Local Anesthesia (General)

Rapid Review

  • Background
    • Direct injection of local anesthetics (lidocaine, bupivacaine, etc.) into the tissues to block transmission of impulses in nerve fibers and provide a temporary loss of sensation, generally for the purposes of reducing pain for further surgical intervention.
  • Indications
    • For anesthesia prior to wound closure, incision/drainage, or other painful procedures. 
  • Contraindications
    • Allergies to anesthetic agent
  • Complications
    • Unintentional intravenous injection, pain/discomfort, infection

Pearls

Video Credit: MiniMedLessons


Median Nerve Block

Rapid Review

  • Background
    • Injection of local anesthetic around the median nerve to anesthetize the volar surface of the thenar half of the hand and the dorsal surfaces of corresponding fingertips, excluding the thumb
  • Indications
    • Ring removal
    • Laceration repair within region of the median nerve
  • Contraindications
    • Overlying infection, allergy to anesthetic agent, coagulopathy.
  • Complications
    • Anesthetic toxicity, infection, nerve injury, hematoma

Pearls

Video Credit: RAUKvideos


Occipital Nerve Block

Rapid Review

  • Background
    • Injection of local anesthetic along the greater and lesser occipital nerves. 
  • Indications
    • Migraine (refractory to conservative treatment), cluster headache, occipital neuralgia, cervicogenic headache
  • Contraindications
    • Overlying skin infection at injection site
  • Complications
    • Rare, but include bleeding, infection, and damage to surrounding structures

Pearls

Video Credit: CHA Communications


Radial Nerve Block

Rapid Review

  • Background
    • Injection of local anesthetic around the radial nerve to anesthetize the dorsum of the thenar half of the hand.
    • Can block at the humerus, elbow, or wrist level
  • Indications
    • Ring removal
    • Laceration of the dorsum of the radial (lateral half of the hand). Excluding fingertips
  • Contraindications
    • Overlying soft tissue infection, allergy to anesthetic agent
  • Complications
    • Infection, nerve injury, anesthetic toxicity

Pearls

Video Credit: NYSORA


Serratus Anterior Nerve Block

Rapid Review

  • Background
    • Injection of local anesthetic around the thoracic intercostal nerves to provide regional anesthesia to the anterolateral chest wall
  • Indications
    • Rib fractures, rib contusions, thoracotomy
  • Contraindications
    • Overlying soft tissue infection, allergy to local anesthetic
  • Complications
    • Pneumothorax, infection, vascular injury

Pearls

Video Credit: Temple EM


Sphenopalatine Ganglion Block

Rapid Review

  • Background
    • Application of local anesthetic to the sphenopalatine ganglion located behind the nose. 
  • Indications
    • Acute cluster headaches, migraine, trigeminal neuralgia, herpes zoster neuralgia
  • Contraindications
    • Allergy to anesthetic, infection within intranasal canal, altered patient.
  • Complications
    • Bleeding, infection, epistaxis

Pearls

Video Credit: ALiEM


Trigger Point Injection

Rapid Review

  • Background
    • Injection of local anesthetic into area of focal, hyper-irritated muscle spasm for pain relief.
  • Indications
    • Focal, reproducible pain with movement/palpation in a defined, accessible location.
  • Contraindications
    • Allergy to anesthetic, overlying skin infection, coagulopathy/bleeding disorder
  • Complications
    • Bleeding, infection, pain

Pearls

Video Credit: Larry Mellick

Brandon Simpson, PA-C
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