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Archive April 2014 XV, No. 4

Basics of Blocks

Everything you need to place ultrasound-guided peripheral nerve blocks.

Dave Berkheimer, BSN, CRNA


ultrasound-guided blocks CUTTING EDGE Ultrasound-guided blocks are considered state of the art.

Regional anesthesia equipment has undergone a significant overhaul in the last decade. Transitioning from the stimulation era to the ultrasound era has left many practitioners behind. Many are stubbornly holding onto the thought that stimulation techniques are just as safe and adequate as ultrasound-guided technology. But that's just simply not the case.

In the hands of a trained practitioner, ultrasound technology allows for direct 2-dimensional, 3-dimensional and even 4-dimensional visualization of the anatomical structure and landmarks used in regional anesthesia, not only for peripheral nerve blocks, but also for spinal-epidural placement. This direct visualization reduces needle passes, inadvertent intravascular punctures and injections, and intraneural injuries, while decreasing anesthetic volumes and increasing block success. Here's a look at what you need to do ultrasound-guided blocks efficiently.

  • Get training. Anesthesia providers should seek out advanced training. Ultrasound regional courses are now available throughout the country with CEU credits at very reasonable pricing. Courses are short and very helpful, often only 2 days. If possible, attend a cadaver course. These types of courses offer hands-on needling, which allows for the best ultrasound education.
  • Appoint a block nurse. A block nurse can be crucial to the successful placement of perineural catheters. Block RNs are nurses with advanced training in ACLS, PALS and BLS, who can provide conscious sedation and have advanced training assisting specifically in ultrasound-guided regional anesthesia techniques. You can train block nurses on the job or have them enroll in a formal short course.
  • Educate patients. We often fail to educate patients about nerve blocks, particularly patients that receive continuous catheters. Preprinted educational materials and 24-hour phone access are important for patients returning home with continuous catheters. At discharge, give patients and their caregivers detailed instructions regarding the care, complications and risks of their continuous catheters.
  • Designate a block bay/room. Ultrasound-guided regional techniques are safest when performed in a designated space with access to all the appropriate equipment and emergency supplies. Adequate work space, lighting, monitoring and privacy allow for more efficient, safe and successful blocks. Blocks may not be limited to the block area, so it's important that your equipment be portable.
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