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Archive October 2017 XVIII, No. 10

Winning With Nerve Blocks

20 little-known facts about regional anesthesia that could be holding you back.

Emily Winchester

Emily Winchester, RN


Brandon Winchester

Brandon Winchester, MD


starting with your needle PROPER NEEDLE PLACEMENT Starting with your needle about the depth of your target in centimeters away from the probe lets you create an angle of entry to the skin ideal for needle visualization.

We're a married couple that lives, eats and breathes nerve blocks. Brandon is an anesthesiologist who specializes in placing blocks at the famed Andrews Institute for Orthopedics & Sports Medicine. Emily is the founder of, an educational site for the regional anesthesia nursing specialty, and the director of the Blockjocks Research & Education Foundation. Yes, we're passionate about regional anesthesia. That's why it's so difficult for us to accept that so many facilities aren't fully capitalizing on the magic of nerve blocks: shorter recovery times, less post-op pain, and faster recoveries and discharges. Maybe debunking these 20 common myths and misconceptions will help.

1. I need a dedicated block room. So very often we hear, "We don't have space for a block room." No worries. You can turn you pre-op or PACU bay (private or not) into a safe area to perform blocks. All you need are trained nurses, custom block trays, standard vital sign monitors and extra Mayo stands.

2. We'll have to stock so many needles. If you have to choose just one, stock 4-inch needles. This length needle is not only the most versatile in regards to what procedures you can use it for (we think almost all of them!), but it also is the length that, for most blocks, lets you begin your insertion site 3-4 cm away from the ultrasound probe. This lets your needle come under the transducer at a nice perpendicular angle, giving you excellent visualization for a safe and highly effective block.

3. I have to keep my ultrasound probe sterile. Single-shot blocks are not sterile procedures. Save your money on probe covers and wear and tear on your transducer by not applying Tegaderm dressing on the probe. Although the single-shot block is a clean procedure, sterility in regards to the ultrasound probe and gloves is unnecessary. Clean your equipment between uses and clean the surface area for the block beforehand. And as always, just like an IV start, your single-shot needle must remain sterile until insertion time after a chlohexidine prep of the insertion site.

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